Implementation of a physician-led lipid-lowering protocol significantly increased PCSK9 inhibitor use (15.3% vs. 2.8%, p=0.002) and lowered chronic LDL levels (51.0 vs. 58.0 mg/dL, p=0.007).
Cohort (n=194)
No
Does a physician-led lipid-lowering protocol incorporating early PCSK9 inhibitor initiation improve prescription rates and lower chronic-phase LDL-C levels in patients with acute myocardial infarction?
Implementing a physician-led protocol that assesses LDL-C on hospital day 2 significantly increases the early prescription of PCSK9 inhibitors and improves long-term LDL-C target achievement in patients with acute myocardial infarction.
Absolute Event Rate: 15.3% vs 2.8%
p-value: p=0.002
AIMS: Intensive lipid-lowering therapy is recommended for secondary prevention of cardiovascular events after acute myocardial infarction (AMI). However, the prescription rate of PCSK9 inhibitors (PCSK9is) remains low among patients not achieving low-density lipoprotein (LDL) cholesterol target levels. METHODS: A retrospective analysis was conducted on 194 patients with AMI who were discharged alive and followed up as outpatients at our institution between October 2022 and October 2024. In October 2023, we implemented the Physician-led Strike Early-Strike Strong Lipid-Lowering Protocol (Physician-led Protocol) to enhance lipid management. Patients were divided into two groups: pre-protocol (October 2022-September 2023) and post-protocol (October 2023-October 2024). Patient background characteristics, lipid-lowering therapies, and LDL cholesterol levels in the chronic phase were compared between the two groups. The outcomes included post-discharge PCSK9i initiation rates and chronic-phase LDL levels. RESULTS: While the prescription rates of strong statins and ezetimibe were similar between the groups, PCSK9i use was significantly higher in the post-protocol group than in the pre-protocol group (15.3% vs. 2.8%, p = 0.002). Furthermore, the chronic LDL levels were significantly lower in the post-protocol group than in the pre-protocol group (51.0 vs. 58.0 mg/dL, p = 0.007). Multivariate logistic regression showed that initial LDL levels and PCSK9i use were associated with achieving chronic LDL levels ＜55 mg/dL. Among eligible patients in the post-protocol group, 36.4% received PCSK9is. CONCLUSIONS: The physician-led protocol increased PCSK9i prescriptions, achieving a median chronic LDL level of 51 mg/dL.
Arai et al. (Tue,) conducted a cohort in Acute Myocardial Infarction (n=194). Physician-led Strike Early-Strike Strong Lipid-Lowering Protocol vs. Pre-protocol standard care was evaluated on Post-discharge PCSK9i initiation rates (p=0.002). Implementation of a physician-led lipid-lowering protocol significantly increased PCSK9 inhibitor use (15.3% vs. 2.8%, p=0.002) and lowered chronic LDL levels (51.0 vs. 58.0 mg/dL, p=0.007).