Why the study?
The study aimed to investigate the effects of preoperative loading-dose statins combined with a PCSK9 inhibitor on coronary blood perfusion and short-term cardiovascular adverse events in STEMI patients.
Does preoperative treatment with a loading dose of statins combined with a PCSK9 inhibitor improve coronary blood perfusion in patients with STEMI undergoing primary PCI?
Does preoperative treatment with a loading dose of statins combined with a PCSK9 inhibitor improve coronary blood perfusion in patients with STEMI undergoing primary PCI?
Preoperative loading with statins and a PCSK9 inhibitor improves coronary blood flow and myocardial perfusion after primary PCI in STEMI patients, though it did not significantly reduce short-term clinical events in this small cohort.
May improve perfusion in STEMI; hypothesis-generating for pre-PCI PCSK9 loading, requires RCT confirmation before practice change.
Objective: This study was aimed at investigating the effects of preoperative treatment with a loading dose of statins combined with a PCSK9 inhibitor on coronary blood perfusion and short-term cardiovascular adverse events in patients with ST-segment elevation myocardial infarction (STEMI). Method: Sixty-five patients with STEMI who had visited the Shanxi Cardiovascular Disease Hospital between May 2018 and May 2021 were enrolled in the study. The enrolled patients had no history of oral statins or antiplatelet therapy. The patients were divided into a combined treatment group (loading dose of statins combined with PCSK9 inhibitors, 35 patients) and a routine treatment group (loading dose of statins only, 30 patients). The primary endpoints were thrombolysis in myocardial infarction (TIMI) blood flow grading, corrected TIMI frame count (CTFC), and TIMI myocardial perfusion grading (TMPG), immediately after and 30 days after the operation. The secondary endpoint was a composite endpoint of cardiovascular death, nonfatal myocardial infarction, and target vessel revascularization 30 days after the operation. Results: The combined treatment group had significantly lower CTFC (14.09±8.42 vs 26±12.42, P=0.04) and better TMPG (2.74±0.61 vs 2.5±0.73, P=0.04) than the routine treatment group immediately after the operation. Similarly, the combined treatment group had a significantly lower CTFC (16.29±7.39 vs 26.23±11.53, P=0.04) and significantly better TMPG (2.94±0.24 vs 2.76±0.43, P=0.01) than the routine treatment group 1 month after the operation. Conclusion: Preoperative treatment with a loading dose of high-intensity statins combined with PCSK9 inhibitors increased coronary blood flow and myocardial perfusion after emergency thrombus aspiration in patients with STEMI. However, the treatment did not significantly decrease the incidence of cardiovascular death, nonfatal myocardial infarction, or target vessel revascularization.
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Wang et al. (2022) studied this question.
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