Key result
PCSK9 inhibitors reduce MACE by ~13% vs. control in acute coronary syndrome.
Why the study?
The effect of PCSK9 inhibitors on blood lipids and major adverse cardiovascular events remains controversial in patients with ACS.
Do PCSK9 inhibitors reduce MACEs and improve blood lipid profiles in patients with acute coronary syndrome compared to statins alone or placebo?
Meta-Analysis (n=48,621)
Do PCSK9 inhibitors reduce MACEs and improve blood lipid profiles in patients with acute coronary syndrome compared to statins alone or placebo?
Relative Risk: 0.87 (95% CI 0.83–0.91)
p-value: p=<0.00001
In patients with acute coronary syndrome, PCSK9 inhibitors significantly lower LDL-C levels and reduce the risk of major adverse cardiovascular events compared to statins or placebo, despite a slight increase in drug-induced adverse events.
Supports PCSK9 inhibitor consideration in acute coronary syndrome for MACE reduction; extends evidence from mixed randomized and observational studies.
BACKGROUND: The effect of proprotein convertase subtilisin kexin type (PCSK9) inhibitors on blood lipids and major adverse cardiovascular events (MACEs) is still controversial for acute coronary syndrome (ACS) patients. This study aimed to evaluate the efficacy and safety of PCSK9 inhibitors for ACS patients. METHODS: We searched the following databases until March 2023: PubMed, Embase, Cochrane, Web of Science, CNKI, Chongqing VIP Database and Wan Fang Database. Finally, all randomized controlled trials, retrospective studies and prospective studies were included in the analysis. RESULTS: A total of 20 studies involving 48,621 patients were included in this meta-analysis. The results demonstrated that PCSK9 inhibitors group was more beneficial for ACS patients compared to control group (receiving statins alone or placebo). The meta-analysis showed: there was no significant difference in high density lipoprotein cholesterol between PCSK9 inhibitors group and control group (standard mean difference = 0.17, 95% confidence interval [CI]: -0.02 to 0.36, P = .08), while the level of low density lipoprotein cholesterol in PCSK9 inhibitors group was lower than that in control group (standard mean difference = -2.32, 95% CI: -2.81 to -1.83, P < .00001). Compared with the control group, the PCSK9 inhibitors group also decreased the levels of total cholesterol and triglycerides (mean difference = -1.24, 95% CI: -1.40 to -1.09, P < .00001, mean difference = -0.36, 95% CI: -0.56 to -0.16, P = .0004). Moreover, compared with the control group, PCSK9 inhibitors group could reduce the incidence of MACEs (relative risk [RR] = 0.87, 95% CI: 0.83-0.91; P < .00001). However, this study showed that the incidence of drug-induced adverse events in PCSK9 inhibitors group was higher than that in the control group (RR = 1.15, 95% CI: 1.05-1.25, P < .0001). CONCLUSION: Although this study demonstrates that PCSK9 inhibitors have higher drug-induced adverse events, they can not only reduce low-density lipoprotein cholesterol levels but also reduce the incidence of MACEs simultaneously. However, these findings needed to be further verified through large sample, multicenter, double-blind randomized controlled trials.
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Song et al. (2024) conducted a meta-analysis in Acute coronary syndrome (ACS) (n=48,621). PCSK9 inhibitors vs. Statins alone or placebo was evaluated on Major adverse cardiovascular events (MACEs) (RR 0.87, 95% CI 0.83-0.91, p=<0.00001). PCSK9 inhibitors significantly reduced the incidence of major adverse cardiovascular events by 13% (RR 0.87) compared to statins alone or placebo in patients with acute coronary syndrome.
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