Key result
Higher PCSK9 linked to ~39% higher stroke risk in post-PCI STEMI patients with elevated P-selectin.
Why the study?
Do high serum PCSK9 levels increase the risk of ischemic stroke in STEMI patients post-PCI, and is this risk modulated by P-selectin levels?
Cohort (n=1,176)
Do high serum PCSK9 levels increase the risk of ischemic stroke in STEMI patients post-PCI, and is this risk modulated by P-selectin levels?
Hazard Ratio: 1.393 (95% CI 0.718–1.047)
p-value: p=0.0229
High PCSK9 levels are associated with an increased risk of ischemic stroke in STEMI patients post-PCI specifically when systemic inflammation (indicated by elevated P-selectin) is high.
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.
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Zhao et al. (2025) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) (n=1,176). Logarithm PCSK9 level (per unit increase) vs. Lower PCSK9 levels was evaluated on ischemic stroke (HR 1.393, 95% CI 0.718 to 1.047, p=0.0229). In STEMI patients post-PCI with P-selectin > median, per unit increase of logarithm PCSK9 level was associated with a 39% increase in stroke risk (HR 1.393; 95% CI 0.718-1.047; p=0.0229).
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