Real-Word Effectiveness of Early Start-Up and Short-Term Use of PCSK9 Inhibitor in the Treatment of Acute Coronary Syndrome in China

Patients with acute coronary syndrome (ACS) are at a high risk of recurrent event especially in the early phase. 1 Li S Peng Y Wang X Qian Y Xiang P Wade SW Guo H Lopez JAG Herzog CA Handelsman Y. Cardiovascular events and death after myocardial infarction or ischemic stroke in an older Medicare population. Clin Cardiol. 2019; 42: 391-399 Crossref PubMed Scopus (37) Google Scholar ,2 Schüpke S Neumann FJ Menichelli M Mayer K Bernlochner I Wöhrle J Richardt G Liebetrau C Witzenbichler B Antoniucci D Akin I Bott-Flügel L Fischer M Landmesser U Katus HA Sibbing D Seyfarth M Janisch M Boncompagni D Hilz R Rottbauer W Okrojek R Möllmann H Hochholzer W Migliorini A Cassese S Mollo P Xhepa E Kufner S Strehle A Leggewie S Allali A Ndrepepa G Schühlen H Angiolillo DJ Hamm CW Hapfelmeier A Tölg R Trenk D Schunkert H Laugwitz KL Kastrati A ISAR-REACT 5 Trial InvestigatorsTicagrelor or prasugrel in patients with acute coronary syndromes. N Engl J Med. 2019; 381: 1524-1534 Crossref PubMed Scopus (513) Google Scholar Both the rapid low density lipoprotein cholesterol (LDL-C) reduction to meet with the target and the duration of lipid-lowering therapy are tidely associated with the risk of ACS. Lowering LDL-C rapidly after myocardial infarction significantly reduces all adverse cardiovascular outcomes. 3 Schubert J Lindahl B Melhus H Renlund H Leosdottir M Yari A Ueda P James S Reading SR Dluzniewski PJ Hamer AW Jernberg T Hagström E Low-density lipoprotein cholesterol reduction and statin intensity in myocardial infarction patients and major adverse outcomes: a Swedish nationwide cohort study. Eur Heart J. 2021; 42: 243-252 Crossref PubMed Scopus (71) Google Scholar Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor is a new type of lipid-lowering drug which has been gradually widely used in recent years. The FOURIER trial (the Further cardiovascular outcomes Research with PCSK9 Inhibition in subjects with Elevated Risk trial) 4 Sabatine MS Giugliano RP Keech A Honarpour N Wang H Liu T Wasserman SM Scott R Sever PS Pedersen TR Rationale and design of the Further cardiovascular outcomes Research with PCSK9 Inhibition in subjects with Elevated Risk trial. Am Heart J. 2016; 173: 94-101 Crossref PubMed Scopus (164) Google Scholar with evolocumab and the ODYSSEY OUTCOMES trial 5 Schwartz GG Steg PG Szarek M Bhatt DL Bittner VA Diaz R Edelberg JM Goodman SG Hanotin C Harrington RA Jukema JW Lecorps G Mahaffey KW Moryusef A Pordy R Quintero K Roe MT Sasiela WJ Tamby JF Tricoci P White HD Zeiher AM ODYSSEY OUTCOMES Committees and InvestigatorsAlirocumab and cardiovascular outcomes after acute coronary syndrome. N Engl J Med. 2018; 379: 2097-2107 Crossref PubMed Scopus (1988) Google Scholar with alirocumab demonstrated 15% overall reductions in major adverse cardiovascular event while using PCSK9 inhibitor for a long time. OCT study 6 Yano H Horinaka S Ishimitsu T Effect of evolocumab therapy on coronary fibrous cap thickness assessed by optical coherence tomography in patients with acute coronary syndrome. J Cardiol. 2020; 75: 289-295 Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar suggests that short-term combined use of statins and PCSK9 inhibitor in patients with ACS in the acute phase can increase the thickness of a thin fibrous cap and promote the regression of plaque volume. 2022 Association for Acute CardioVascular Care 7 Krychtiuk KA Ahrens I Drexel H Halvorsen S Hassager C Huber K Kurpas D Niessner A Schiele F Semb AG Sionis A Claeys MJ Barrabes J Montero S Sinnaeve P Pedretti R Catapano A Acute LDL-C reduction post ACS: strike early and strike strong: from evidence to clinical practice. A clinical consensus statement of the Association for Acute CardioVascular Care (ACVC), in collaboration with the European Association of Preventive Cardiology (EAPC) and the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy. Eur Heart J Acute Cardiovasc Care. 2022; 11: 939-949 PubMed Google Scholar proposes a lipid-lowering strategy of 'strike early and strike strong' in all patients with ACS and suggests that acute PCSK-9 inhibition is a novel strategy.