Aims: No data are available on early initiation of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) in patients with acute coronary syndrome (ACS) in real-world. This study investigates the effects of PCSK9i started at time of ACS hospitalization on lipid control and major CV events in real-world. Methods: The lipid control outcome was the percentage of patients reaching the LDL-C target of < 55 mg/dL at first lipid control. The clinical outcome was the incidence of composite major CV events (all cause death, non-fatal MI, non-fatal stroke, and ischemia-driven revascularization) during follow-up in relation to quartiles of LDL-C at first lipid control. Results: We included 771 patients with ACS from AT-TARGET-IT registry, receiving PCSK9i prescription during hospitalization or at discharge. Median LDL-C was 137 mg/dL and decreased to 43 mg/dL at first lipid control. 527 (68.3%) patients achieved LDL-C target at the first lipid control at a median time of 37 days from hospitalization; of them, 404 (76.8%) were discharged on statin plus ezetimibe background therapy. Event curves through a median follow-up of 11 months across quartiles of LDL-C showed a stepwise lower risk of 4P-MACE, 3P-MACE, all-cause mortality, and ischemia-driven revascularization in lower quartile of LDL-C values at first lipid control (<23 mg/dL) and in patients reaching LDL-C <55 mg/dL. Conclusions: Intensive and early lipid-lowering therapy using PCSK9i in patients with ACS (strike early strike strong strategy) is safe and effective in clinical practice and associated with a reduction of residual CV risk.
Strike early-strike strong lipid-lowering strategy with PCSK9i in ACS patients. Real-world evidence from AT-TARGET-IT registry / Gargiulo, Paola; Basile, Christian; Galasso, Gennaro; Bellino, Michele; D'Elia, Debora; Patti, Giuseppe; Bosco, Manuel; Prinetti, Matteo; Andò, Giuseppe; Campanella, Francesca; Taverna, Giovanni; Calabrò, Paolo; Cesaro, Arturo; Fimiani, Fabio; Catalano, Angelo; Varbella, Ferdinando; Corleto, Antonella; Barillà, Francesco; Muscoli, Saverio; Musumeci, Giuseppe; Delnevo, Fabrizio; Giallauria, Francesco; Napoli, Raffaele; Porto, Italo; Polimeni, Alberto; Quarta, Rossella; Maloberti, Alessandro; Merlini, Piera Angelica; De Luca, Leonardo; Casu, Gavino; Brunetti, Natale Daniele; Crisci, Mario; Paloscia, Leonardo; Bilato, Claudio; Indolfi, Ciro; Marzano, Federica; Fontanarosa, Sara; Buonocore, Davide; Parlati, Antonio Luca Maria; Nardi, Ermanno; Prastaro, Maria; Soricelli, Andrea; Salvatore, Marco; Paolillo, Stefania; Perrone-Filardi, Pasquale. - In: EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY. - ISSN 2047-4873. - (2024). [10.1093/eurjpc/zwae170]
Strike early-strike strong lipid-lowering strategy with PCSK9i in ACS patients. Real-world evidence from AT-TARGET-IT registry
Gargiulo, Paola;Basile, Christian;Galasso, Gennaro;Giallauria, Francesco;Napoli, Raffaele;Indolfi, Ciro;Marzano, Federica;Fontanarosa, Sara;Buonocore, Davide;Parlati, Antonio Luca Maria;Nardi, Ermanno;Prastaro, Maria;Soricelli, Andrea;Paolillo, Stefania;Perrone-Filardi, Pasquale
2024
Abstract
Aims: No data are available on early initiation of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) in patients with acute coronary syndrome (ACS) in real-world. This study investigates the effects of PCSK9i started at time of ACS hospitalization on lipid control and major CV events in real-world. Methods: The lipid control outcome was the percentage of patients reaching the LDL-C target of < 55 mg/dL at first lipid control. The clinical outcome was the incidence of composite major CV events (all cause death, non-fatal MI, non-fatal stroke, and ischemia-driven revascularization) during follow-up in relation to quartiles of LDL-C at first lipid control. Results: We included 771 patients with ACS from AT-TARGET-IT registry, receiving PCSK9i prescription during hospitalization or at discharge. Median LDL-C was 137 mg/dL and decreased to 43 mg/dL at first lipid control. 527 (68.3%) patients achieved LDL-C target at the first lipid control at a median time of 37 days from hospitalization; of them, 404 (76.8%) were discharged on statin plus ezetimibe background therapy. Event curves through a median follow-up of 11 months across quartiles of LDL-C showed a stepwise lower risk of 4P-MACE, 3P-MACE, all-cause mortality, and ischemia-driven revascularization in lower quartile of LDL-C values at first lipid control (<23 mg/dL) and in patients reaching LDL-C <55 mg/dL. Conclusions: Intensive and early lipid-lowering therapy using PCSK9i in patients with ACS (strike early strike strong strategy) is safe and effective in clinical practice and associated with a reduction of residual CV risk.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.