Why the study?
Despite evidence-based therapies, one-year mortality after acute MI remains at 12-15%, leaving a need to further reduce MI-related complications.
Does PCSK9 inhibition reduce mortality in patients after acute myocardial infarction?
Does PCSK9 inhibition reduce mortality in patients after acute myocardial infarction?
PCSK9 inhibition is recommended early after acute MI to reduce LDL-C and morbidity, and its potential to reduce mortality warrants testing in an appropriately powered RCT.
Reinforces early PCSK9 inhibitor use post-MI for LDL-C reduction; leaves mortality benefit open pending powered RCTs.
In this review, we explore the role of PCSK9 and the inhibition of PCSK9 in patients after acute myocardial infarction (MI). Despite the implementation of evidencebased therapies to improve outcomes, one-year mortality remains at 12-15%, and there is still a need to further reduce complications related to MI. Mechanistic and epidemiologic studies have suggested that the naturally occurring PCSK9 protein increases coronary plaque vulnerability through several pathways, including pro-inflammatory LDL-C oxidation and direct modification of plaque composition. PCSK9 inhibitors are a class of drugs with proven efficacy in patients with recent MI. The latest guidelines recommend the use of PCSK9 inhibitors in patients with recent MI early in the process of care to reduce LDL-C values and associated morbidity. The use of PCSK9 inhibition could be beneficial for mortality reduction after an acute MI and should be tested in an appropriately powered randomized controlled trial.
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Gencer et al. (2021) studied this question.
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