Key result
In-hospital alirocumab initiation is linked to ~38% lower odds of 1-year MACE vs. control.
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Why the study?
The real-world impact of early in-hospital PCSK9 inhibitor initiation on clinical outcomes in Chinese ACS patients was not well evaluated.
Does early in-hospital initiation of alirocumab reduce MACE and improve LDL-C goal attainment in Chinese patients with acute coronary syndrome?
Cohort (n=32,070)
Yes
Does early in-hospital initiation of alirocumab reduce MACE and improve LDL-C goal attainment in Chinese patients with acute coronary syndrome?
Odds Ratio: 0.62 (95% CI 0.48–0.78)
Absolute Event Rate: 2.76% vs 3.95%
p-value: p=<0.001
Real-world in-hospital initiation of alirocumab in Chinese ACS patients is associated with a significantly lower 1-year risk of MACE and earlier, more frequent achievement of LDL-C goals.
BACKGROUND AND AIMS To evaluate the real-world impact of early in-hospital Proprotein Convertase Subtilisin-Kexin Type 9 (PCSK9) inhibitor initiation on clinical outcomes in Chinese acute coronary syndrome (ACS) patients. METHODS This retrospective study analyzed ACS patients (2021-2023) from the CCA Database-Chest Pain Center, comparing alirocumab-treated (n = 6414) and control (n = 25,656) groups after propensity score matching. Outcomes included 1-year major adverse cardiovascular events (MACE) (defined as the composite of non-fatal myocardial infarction, non-fatal ischemic stroke, all-cause mortality, or any coronary revascularization) via Kaplan-Meier analysis and low-density lipoprotein cholesterol (LDL-C) goal attainment (<1.4 mmol/L) at 1/3/6 months. Logistic regression was performed to identify predictors. RESULTS The alirocumab group showed a significantly lower MACE incidence rate during 1-year of follow-up (2.76 vs 3.95 per 100 person-years, p = 0.003). At follow-up, LDL-C measurements were available in 293, 123, and 33 patients in the alirocumab group and 1759, 984, and 424 patients in the control group at 1, 3, and 6 months, respectively. More patients in the alirocumab group reached the LDL-C goal at 1-month (58.02% vs. 24.33%, p < 0.001). This trend remained consistent during the subsequent 3-month (52.85% vs. 23.88%, p < 0.001) and 6-month follow-up (51.52% vs. 26.18%, p = 0.002). Participation in the ACS Pathway Optimization project (OR = 0.49; 95% CI 0.29, 0.77; p = 0.004), in-hospital initiation of alirocumab (OR = 0.62; 95% CI 0.48, 0.78; p < 0.001), male (OR = 0.71; 95% CI 0.58, 0.87; p < 0.001) were significantly negatively associated with the occurrence of MACE event, and in-hospital initiation of alirocumab (OR = 4.29; 95% CI 3.23, 5.71; p < 0.001), male (OR = 1.47; 95% CI 1.09, 2.00; p = 0.014), hypertension (OR = 1.31; 95% CI 1.06, 1.63; p = 0.012) and lipid lowering treatment statin and ezetimibe (OR = 2.20; 95% CI 1.58, 3.07; p < 0.001) were significantly positively associated with 1-month LDL-C goal attainment. CONCLUSION In-hospital initiation of alirocumab was associated with a lower risk of MACE and with higher LDL-C goal attainment in China real-world ACS patients.
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Yu et al. (2026) conducted a cohort in Acute Coronary Syndrome (ACS) (n=32,070). In-hospital initiation of alirocumab vs. Control was evaluated on 1-year major adverse cardiovascular events (MACE) (composite of non-fatal myocardial infarction, non-fatal ischemic stroke, all-cause mortality, or any coronary revascularization) (OR 0.62, 95% CI 0.48-0.78, p=<0.001). In-hospital initiation of alirocumab was associated with a lower rate of 1-year MACE compared to control (2.76 vs 3.95 per 100 person-years; OR 0.62, 95% CI 0.48-0.78, p<0.001).
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