PCSK9 Inhibitors “Fast Track” Use Versus “Stepwise” Lipid-Lowering Therapy in Patients with Acute Coronary Syndrome: A Retrospective Single-Center Study in a “Real-World” Population

<b>Background</b>: The "fast track" addition (within 48 h) of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) to the optimized oral lipid-lowering therapy (LLT) during hospitalization for acute coronary syndrome (ACS) has been shown to rapidly achieve the low-density lipoprotein cholesterol (LDL-C) therapeutic targets. However, so far, its efficacy in real-world settings remains understudied. <b>Methods</b>: We retrospectively analyzed 128 ACS patients treated at our center, comparing "PCSK9i fast track" use within 48 h to standard "stepwise" LLT. Lipid levels and incidence of major adverse cardiovascular events (MACEs) were evaluated at 30 and 180 days. <b>Results</b>: The "PCSK9i fast track" group achieved significantly lower LDL-C levels at 30 days (41.5 ± 27.5 vs. 85.6 ± 35.9 mg/dL, <i>p</i> < 0.001) and 180 days (29.6 ± 21.0 vs. 59.0 ± 32.4 mg/dL, <i>p</i> < 0.001). Recommended LDL-C targets (<55 mg/dL) were met by 88.3% of the "PCSK9i fast track" group at 180 days, compared with 61.9% of controls (<i>p</i> < 0.001). No significant differences in MACEs were observed between groups. No adverse effects from PCSK9i use were noted. <b>Conclusions</b>: The "PCSK9i fast track" strategy was safe and effective in achieving LDL-C targets more rapidly than conventional approaches in real-world ACS patients.