Abstract This study aimed to investigate the impact of P-selectin on proprotein convertase subtilisin/kexin type 9 (PCSK9) associated cardiovascular risk in patients with ST-segment elevation myocardial infarction (STEMI) underwent percutaneous coronary intervention (PCI). A total of 1176 STEMI-PCI patients were prospectively recruited, and further stratified based on P-selectin levels (≤ median vs ＞ median mg/L). The major endpoints were defined as ischemic stroke; the secondary endpoints were all-cause death, revascularization, and myocardial infarction. During a mean follow-up of 2.5 years, stroke occurred in 39 (3.316%) patients. In the setting of serum P-selectin ＞median, per unit increase of logarithm PCSK9 level was associated with a 39% increase of stroke risk (HR: 1.393, 95% CI: 0.718 to 1.047, p = 0.0229); However, the tendency was absence in the group of P-selectin ≤median. Patients with upper quartiles of PCSK9 (Q4) had a significant lower event-free survival (HR 4.343, 95% CI: 1.141 to 16.537, p = 0.031 for interaction) when sP-selectin＞median. No similar association between PCSK9 and P-selectin was noted when sP-selectin≤median.In conclusion, high PCSK9 levels were associated with poor prognosis when serum P-selectin ＞median, implying systemic inflammation can modulate thrombosis-associated stroke risk in STEMI-PCI patients. Measurement of platelet activation markers in patients with high inflammation risk may identify individuals at high cardiovascular risk. Measurement of PCSK9 in patients with high platelet activation risk may identify individuals at high cardiovascular risk.KM Curve of PCSK9
Zhao et al. (Sat,) studied this question.