Strike early-strike strong lipid-lowering strategy with proprotein convertase subtilisin/kexin type 9 inhibitors in acute coronary syndrome patients: real-world evidence from the AT-TARGET-IT registry.
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Gargiulo Paola, Basile Christian, Galasso Gennaro, Bellino Michele, D'Elia Debora, Patti Giuseppe, Bosco Manuel, Prinetti Matteo, Andò Giuseppe, Campanella Francesca, Taverna Giovanni, Calabrò Paolo, Cesaro Arturo, Fimiani Fabio, Catalano Angelo, Varbella Ferdinando, Corleto Antonella, Barillà Francesco, Muscoli Saverio, Musumeci Giuseppe, Delnevo Fabrizio, Giallauria Francesco, Napoli Raffaele, Porto Italo, Polimeni Alberto, Quarta Rossella, Maloberti Alessandro, Merlini Piera Angelica, De Luca Leonardo, Casu Gavino, Brunetti Natale Daniele, Crisci Mario, Paloscia Leonardo, Bilato Claudio, Indolfi Ciro, Marzano Federica, Fontanarosa Sara, Buonocore Davide, Parlati Antonio Luca Maria, Nardi Ermanno, Prastaro Maria, Soricelli Andrea, Salvatore Marco, Paolillo Stefania, Perrone-Filardi Pasquale, Cuomo Gianluigi, Testa Crescenzo, Passaretti Gianluca, Vallefuoco Giuseppe, Romano Annalisa, Dell'Anno Raffaele, Merolla Aurora, Iannone Francesca Paola
Аннотация
METHODS AND RESULTS: The lipid control outcome was the percentage of patients reaching the LDL-C target of <55 mg/dL at first lipid control. The clinical outcome was the incidence of composite major CV events (all-cause death, non-fatal MI, non-fatal stroke, and ischaemia-driven revascularization) during a follow-up in relation to quartiles of LDL-C at first lipid control. We included 771 patients with ACS from the AT-TARGET-IT registry, receiving PCSK9i prescription during hospitalization or at discharge. Median LDL-C was 137 mg/dL and decreased to 43 mg/dL at first lipid control. 527 (68.3%) patients achieved LDL-C target at the first lipid control at a median time of 37 days from hospitalization; of them, 404 (76.8%) were discharged on statin plus ezetimibe background therapy. Event curves through a median follow-up of 11 months across quartiles of LDL-C showed a stepwise lower risk of 4P-MACE, 3P-MACE, all-cause mortality, and ischaemia-driven revascularization in lower quartile of LDL-C values at first lipid control (<23 mg/dL) and in patients reaching LDL-C < 55 mg/dL.
CONCLUSION: Intensive and early lipid-lowering therapy using PCSK9i in patients with ACS (strike early-strike strong strategy) is safe and effective in clinical practice and associated with a reduction of residual CV risk.