Effects of PCSK9 inhibitors on coronary atheroma morphology in patients with coronary artery disease treated with statins: a meta-analysis and systematic review.

BACKGROUND

Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) reduce adverse cardiovascular events when added to statins, but their effects on coronary plaque morphology remain inadequately defined.

METHODS

We searched PubMed via MEDLINE, Cochrane CENTRAL, Scopus, Web of Science for randomized controlled trials comparing the effects of PCSK9i plus statins versus statins alone on coronary atheroma morphology in patients with coronary artery disease, including total atheroma volume (TAV), percent atheroma volume (PAV), fibrous cap thickness (FCT), minimal lumen area (MLA), maximum lipid arc (MLArc), and lipid parameters. Random-effects models pooled mean differences (MDs).

RESULTS

Of 1,472 abstracts screened, eight randomized controlled trials (n = 1,898; PCSK9i+statin n = 950; statins alone n = 948) met inclusion criteria with mean follow-up of 59.4 ± 21.4 weeks. Compared with statins alone, PCSK9i plus statins increased FCT (MD 26.48 um, 95% CI 14.00 to 38.96) and reduced MLArc (MD -16.97°, 95% CI -30.90 to -3.04). In IVUS studies, PCSK9i reduced PAV (MD -0.86%, 95% CI -1.16 to -0.55) and TAV (MD -8.95 mm3, 95% CI -15.81 to -2.10); MLA did not differ. PCSK9i also produced larger reductions in LDL-C, total cholesterol, non-HDL-C, triglycerides, ApoB, and Lp(a), with a modest increase in HDL-C.

CONCLUSIONS

The addition of PCSK9i to statin therapy improved coronary atheroma composition and morphology in patients with coronary artery disease.