October 24, 2022Open Access

In-hospital initiation of PCSK9 inhibitor and short-term lipid control in patients with acute myocardial infarction

Structured PICO

Does in-hospital initiation of evolocumab added to statin therapy improve short-term lipid control and reduce readmission in patients with acute myocardial infarction?

Population

7,556 screened patients with acute myocardial infarction (AMI) admitted to a single center in China. Key inclusion: confirmed admission diagnosis of AMI. Key exclusion: severe noncardiac disease with expected survival <1 year, age >80 years, or living far away from the hospital's catchment area.

Intervention

In-hospital initiation of evolocumab (140 mg per 2 weeks, subcutaneous injection) added to statin therapy (20 mg atorvastatin or 10 mg rosuvastatin per day) with or without ezetimibe (10 mg per day).

Comparator

Statin alone (20 mg atorvastatin or 10 mg rosuvastatin per day) or statin plus ezetimibe (10 mg per day).

Outcome

Short-term lipid control (low density lipoprotein [LDL] levels and attainment rate of LDL < 1.4 mmol/L) at 1-month and 3-month follow-up.surrogate

In-hospital initiation of evolocumab in patients with acute myocardial infarction is highly effective for achieving rapid, short-term LDL-C target attainment.

Abstract

BACKGROUND: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been shown to improve cardiovascular outcomes when added to conventional statin therapy. This study aims to investigate the efficacy and safety of in-hospital initiation of PCSK9 inhibitors among patients with acute myocardial infarction (AMI) based on real-world experience. METHODS AND RESULTS: Data were collected from the Biobank of the First Affiliated Hospital of Xi'an Jiaotong University between January 2016 and December 2020. A total of 7556 AMI patients were screened for eligibility. Propensity Score Match (PSM) was employed, and covariates were age, sex, admission blood pressure and lipid profiles. Eligible participants were (1) propensity-matched 1:2:2 of statin plus evolocumab (dual therapy) vs. statin vs. statin plus ezetimibe. Ninety-five statin plus evolocumab users achieved significantly decreased low density lipoprotein (LDL) levels (0.92 ± 0.62 mmol/L in the 1st month and 1.17 ± 0.73 in the 3rd month) and a promising attainment rate of LDL (79.5% in the 1st month and 80.0% in the 3rd month) compared to the other two groups. (2) Propensity-matched 1:2:2 of statin plus ezetimibe evolocumab (triple therapy) vs. statin vs. statin plus ezetimibe. Similarly, 75 triple medication users achieved significantly decreased LDL levels and a promising attainment rate of LDL compared to the other two groups. In-hospital mortality and readmission rates within 3 months were then analyzed, and a decreased readmission rate was observed with PCSK9i therapy. CONCLUSIONS: Based on the present single-center real-world PSM-adjusted study, PCSK9i has been effective in short-term lipid control among AMI patients. The long-term effectiveness for reducing major cardiovascular events among AMI patients based on real-world experience remains to be explored. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov, ClinicalTrials.gov ID: NCT05184530.

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