Possibilities of proprotein convertase subtilisin / kexin type 9 inhibition after acute coronary syndrome

Introduction . Uncorrected dyslipidemia worsens the prognosis after acute coronary syndrome (ACS). The effective lipid-lowering therapy (LLT) may be important including proprotein convertase subtilisin/kexin type 9 inhibitors (iPCSK9). There is not enough data about the effect of iPCSK9 initiation time on ACS outcomes. Aim . To evaluate the effect of iPCSK9 initiation time on ACS outcomes during 18 months of follow-up. Materials and methods . We observed 33 consecutive patients discharged from the hospital who met the following criteria: 1) hospitalization with ACS, 2) low-density lipoprotein cholesterol (LDL-C) > 3.9 mmol/l, 3) consent to visits at 3, 6, 12 and 18 months after ACS, 4) initiation of iPCSK9 therapy within a year after discharge. In 17 patients iPCSK9 therapy was initiated ≥3 months (group 1), and in 16 patients – <3 months after ACS (group 2). LLT was performed in outpatient clinics or regional lipid center. Adverse outcomes were monitored for 18 months. Results . 6 and 12 months after ACS the proportions of individuals with target LDL-C values in group 2 were 2.3 (p = 0.009) and 1.6 (p = 0.024) times higher than in group 1. In groups 1 and 2, the proportions of individuals requiring cardiovascular rehospitalizations were 9 (52.9%) and 2 (12.5%), respectively, p = 0.017. There were no fatal outcomes. The need for rehospitalizations was inversely correlated with the early start of PCSK9-targeted therapy (R = -0.47; p = 0.0001) as well as with the treatment at the lipid center (R = -0.42; p = 0.0004). Conclusions . Early initiation of iPCSK9 is associated with rapid achievement of target LDL-C values in ACS survivors and 4.2-fold reduction in the need for cardiovascular rehospitalizations. The use of a lipid center as a basic institution for LLT also contributes to the lower need for rehospitalizations.