What is the clinical evidence from this study?

Study design: Cohort. Population: Acute ST-Segment Elevation Myocardial Infarction (STEMI) (n=192). Intervention: Alirocumab vs. Conventional treatment. Primary outcome: Composite of major adverse cardiovascular events (MACE) at 12 months (HR 0.606, 95% CI 0.258-1.423, p=0.250).

What does this research mean for the field?

A single dose of alirocumab administered after primary percutaneous coronary intervention in STEMI patients does not significantly reduce major adverse cardiovascular events at 12 months. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the efficacy and safety of a single dose of alirocumab after PPCI in acute STEMI patients.

April 1, 2026Open Access

The Impact of Single-Dose Alirocumab on Efficacy and Safety After Primary Percutaneous Coronary Intervention in Patients With Acute ST-Segment Elevation Myocardial Infarction: A Single-Center Retrospective Real-World Study

Key Result

A single 75 mg dose of alirocumab administered after primary percutaneous coronary intervention in STEMI patients did not significantly reduce major adverse cardiovascular events at 12 months (HR 0.606).

Key Points

To evaluate the efficacy and safety of a single dose of alirocumab after PPCI in acute STEMI patients.
Conducted a retrospective analysis of STEMI patients from May 2023 to May 2024.
Used 1:1 propensity score matching to balance baseline differences between alirocumab and conventional treatment groups.
Assessed major adverse cardiovascular events (MACEs) at 12 months as the primary endpoint.
Observed a non-significant downward trend in MACEs in the alirocumab group compared to conventional treatment.
Significant reduction in low-density lipoprotein cholesterol (LDL-C) at 1 month (p = 0.011).
Improvements in left ventricular end-systolic volume (LVESV, p = 0.009) and quality of life (p = 0.012) noted in the alirocumab group.
No increased incidence of adverse events reported (p > 0.05).

Study Design

Type

Cohort (n=192)

Multicenter

Structured PICO

Does a single dose of alirocumab reduce major adverse cardiovascular events at 12 months in patients with acute STEMI undergoing primary PCI?

Population

192 adults (aged 18-75 years) with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) with post-procedural TIMI flow grade 3 and baseline LDL-C ≥1.8 mmol/L. Mean age ~60 years, ~72% male, single-center cohort in China. Key exclusions: previous PCSK9 inhibitor use, structural heart disease, severe liver/renal dysfunction (eGFR <30).

Intervention

Single 75 mg subcutaneous dose of alirocumab administered within 6 hours following primary PCI, added to standard guideline-directed medical therapy (including moderate-intensity statin and dual antiplatelet therapy).

Comparator

Conventional treatment consisting of standard guideline-directed medical therapy (including moderate-intensity statin and dual antiplatelet therapy) without alirocumab.

Outcome

Composite of major adverse cardiovascular events (MACE) at 12 months post-PPCI, including cardiac death, non-fatal reinfarction, unplanned repeat revascularization, malignant arrhythmia, and readmission for heart failure.composite

Main Result

Effect estimate: HR 0.606 (95% CI 0.258-1.423)

Absolute Event Rate: 8.3% vs 13.5%

p-value: p=0.250

Limitations

Single-center, retrospective, observational design with potential selection and information bias
Modest overall sample size and limited number of primary endpoint events
Follow-up duration limited to 1 year
Retrospective data collection restricted availability of additional clinical indicators
Potential recall bias and indirect assessment of statin adherence
Dynamic inflammatory markers may be influenced by multiple peri-procedural factors
Limited statistical power to detect infrequent or rare safety signals

Abstract

Background: Residual inflammation and persistent lipid abnormalities substantially increase the risk of adverse clinical outcomes in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PPCI). Although proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been shown to improve cardiovascular outcomes, the efficacy, safety, and prognosis of these inhibitors when administered as a single dose after PPCI in real-world practice remain unclear. Method: A retrospective study of patients with acute ST-segment elevation myocardial infarction (STEMI) admitted between May 2023 and May 2024. Patients were assigned to an alirocumab group or a conventional treatment group based on whether a single dose of alirocumab was administered within 6 hours of PPCI. Baseline differences between groups were balanced using 1:1 propensity score matching (PSM). The occurrence of major adverse cardiovascular events (MACEs) at 12 months post-procedure was applied as the primary endpoint. Secondary endpoints included lipid profiles, inflammatory markers, cardiac function, quality-of-life changes, and safety outcomes. Results: A non-significant downward trend in the incidence of MACEs at 12 months post-PPCI was observed in the alirocumab group compared with the conventional treatment group (log-rank p = 0.242). A single dose of alirocumab significantly reduced low-density lipoprotein cholesterol (LDL-C) at 1 month (p = 0.011) and attenuated inflammation markers at 24 hours postoperatively. At 12 months, the alirocumab group showed improved cardiac function with significantly reduced left ventricular end-systolic volume (LVESV, p = 0.009) and modest but statistically significant improvement in quality of life (p = 0.012), primarily driven by enhanced physical activity (p 0.05). Conclusions: This study demonstrated that a single dose of alirocumab in STEMI patients undergoing PPCI was associated with significant improvement in LDL-C levels, attenuation of early postoperative inflammation, and a favorable trend toward improved cardiac function and quality of life, while maintaining an acceptable safety profile.

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