The Impact of Single-Dose Alirocumab on Efficacy and Safety After Primary Percutaneous Coronary Intervention in Patients With Acute ST-Segment Elevation Myocardial Infarction: A Single-Center Retrospective Real-World Study.

BACKGROUND

Residual inflammation and persistent lipid abnormalities substantially increase the risk of adverse clinical outcomes in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PPCI). Although proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been shown to improve cardiovascular outcomes, the efficacy, safety, and prognosis of these inhibitors when administered as a single dose after PPCI in real-world practice remain unclear.

METHOD: A retrospective study of patients with acute ST-segment elevation myocardial infarction (STEMI) admitted between May 2023 and May 2024. Patients were assigned to an alirocumab group or a conventional treatment group based on whether a single dose of alirocumab was administered within 6 hours of PPCI. Baseline differences between groups were balanced using 1:1 propensity score matching (PSM). The occurrence of major adverse cardiovascular events (MACEs) at 12 months post-procedure was applied as the primary endpoint. Secondary endpoints included lipid profiles, inflammatory markers, cardiac function, quality-of-life changes, and safety outcomes.

RESULTS

A non-significant downward trend in the incidence of MACEs at 12 months post-PPCI was observed in the alirocumab group compared with the conventional treatment group (log-rank p = 0.242). A single dose of alirocumab significantly reduced low-density lipoprotein cholesterol (LDL-C) at 1 month (p = 0.011) and attenuated inflammation markers at 24 hours postoperatively. At 12 months, the alirocumab group showed improved cardiac function with significantly reduced left ventricular end-systolic volume (LVESV, p = 0.009) and modest but statistically significant improvement in quality of life (p = 0.012), primarily driven by enhanced physical activity (p < 0.001), alongside reduced insecurity (p < 0.001). No increased incidence of adverse events was observed (p > 0.05).

CONCLUSIONS

This study demonstrated that a single dose of alirocumab in STEMI patients undergoing PPCI was associated with significant improvement in LDL-C levels, attenuation of early postoperative inflammation, and a favorable trend toward improved cardiac function and quality of life, while maintaining an acceptable safety profile.