Early addition of PCSK9 inhibitors to statins significantly reduce LDL-C in STEMI patients undergoing PCI

Canada: Early supplementation of PCSK9 inhibitor along with high-intensity statin further decreases LDL cholesterol (by 22%) in patients undergoing PCI for ST-segment elevation MI (STEMI), says a study published in EuroIntervention journal.

Regardless of LDL-cholesterol levels, early high-intensity statin treatment is the accepted worldwide standard of care for patients with STEMI. Shamir R. Mehta and colleagues carried out this study in order to ascertain the impact of a similar early initiation strategy employing a PCSK9 inhibitor combined to a high-intensity statin on LDL cholesterol in acute STEMI.

In a randomized, double-blind experiment, 68 STEMI patients having primary PCI were randomly allocated to receive alirocumab 150 mg subcutaneously early therapy or a matched sham-control. Regardless of the baseline LDL level, the first injection was given prior to the main PCI, and subsequent ones were given at 2 and 4 weeks. A linear mixed model was used to examine the primary outcome, which was the percent reduction in direct LDL-cholesterol up to 6 weeks.

The key findings of this study were:

1. The percentages of high-intensity statin usage in the alirocumab/sham-control groups were 97% and 100%, respectively.

2. LDL cholesterol was reduced by 72.9% with alirocumab (2.97 mmol/L to 0.75 mmol/L) against 48.1% with a sham-control (2.87 mmol/L to 1.30 mmol/L) at a median of 45 days, for a mean between-group difference of -22.3%.

3. Alirocumab patients were more likely to reach the ESC/EAS dyslipidemia guideline goal LDL1.4 mmol/L (92.1% vs. 56.7%).

4. With similar between-group mean values, LDL decreased during the first 24 hours in both the alirocumab and sham-control groups (-0.01 mmol/L/hour).

In conclusion, alirocumab lowered LDL-cholesterol by 22% when given early in patients undergoing primary PCI for STEMI while they were already on a high-intensity statin. If this streamlined method combined with long-term medication improves cardiovascular outcomes in individuals with acute STEMI, a significant trial is required to establish it.

Reference: 

Mehta, S. R., Pare, G., Lonn, E. M., Jolly, S. S., Natarajan, M. K., Pinilla-Echeverri, N., Schwalm, J.-D., Sheth, T., Sibbald, M., Tsang, M., Valettas, N., Velianou, J. L., McCready, T., & McQueen, M. J. (n.d.). Effects of Routine Early Treatment with PCSK-9 inhibitor in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction: A randomized, double-blind, sham-controlled trial. Pcronline.com.https://doi.org/10.4244/EIJ-D-22-00735