Effects of Loading-Dose Statins Combined with PCSK9 Inhibitor Pre-Treatment before Primary Percutaneous Coronary Intervention on the Short-Term Prognosis in Patients with ST-Segment Elevation Myocardial Infarction

Abstract

Objective: This study was aimed at investigating the effects of preoperative treatment with a loading dose of statinscombined with a PCSK9 inhibitor on coronary blood perfusion and short-term cardiovascular adverse events in patientswith ST-segment elevation myocardial infarction (STEMI).Method: Sixty-five patients with STEMI who had visited the Shanxi Cardiovascular Disease Hospital between May2018 and May 2021 were enrolled in the study. The enrolled patients had no history of oral statins or antiplatelet therapy.The patients were divided into a combined treatment group (loading dose of statins combined with PCSK9 inhibitors, 35patients) and a routine treatment group (loading dose of statins only, 30 patients). The primary endpoints were thrombolysisin myocardial infarction (TIMI) blood flow grading, corrected TIMI frame count (CTFC), and TIMI myocardial perfusiongrading (TMPG), immediately after and 30 days after the operation. The secondary endpoint was a composite endpoint ofcardiovascular death, nonfatal myocardial infarction, and target vessel revascularization 30 days after the operation.Results: The combined treatment group had significantly lower CTFC (14.09 ± 8.42 vs 26 ± 12.42, P = 0.04) and betterTMPG (2.74 ± 0.61 vs 2.5 ± 0.73, P = 0.04) than the routine treatment group immediately after the operation. Similarly,the combined treatment group had a significantly lower CTFC (16.29 ± 7.39 vs 26.23 ± 11.53, P = 0.04) and significantlybetter TMPG (2.94 ± 0.24 vs 2.76 ± 0.43, P = 0.01) than the routine treatment group 1 month after the operation.Conclusion: Preoperative treatment with a loading dose of high-intensity statins combined with PCSK9 inhibitorsincreased coronary blood flow and myocardial perfusion after emergency thrombus aspiration in patients withSTEMI. However, the treatment did not significantly decrease the incidence of cardiovascular death, nonfatal myocardialinfarction, or target vessel revascularization.

PCSK9 inhibitors for acute coronary syndrome: the era of early implementation

“…The corrected TIMI frame count (CTFC) index was significantly lower in the test group immediately after PCI and 30 days after PCI, while the TIMI myocardial perfusion grading (TMPG) index was higher than in the control group (35). However, the treatment did not decrease the incidence of cardiovascular death, non-fatal myocardial infarction, or target vessel revascularization (35).…”

“…The GLAGOV study ( n = 968) suggested that PCSK9 inhibitors could promote regression in plaque composition ( 33 , 50 ). Studies are underway to determine the effects of the early implementation of PCSK9 inhibitors on plaque, blood flow, vascular inflammation, and other relevant imaging features in patients with ACS ( 13 , 15 , 34 , 35 , 51 ).…”

“…Another study by Wang Zhe et al involved 65 STEMI patients, and divided them into the test group (loading dose of statins combined with PCSK9 inhibitors, 35 patients) and the control group (loading dose of statins only, 30 patients) ( 35 ). The corrected TIMI frame count (CTFC) index was significantly lower in the test group immediately after PCI and 30 days after PCI, while the TIMI myocardial perfusion grading (TMPG) index was higher than in the control group ( 35 ). However, the treatment did not decrease the incidence of cardiovascular death, non-fatal myocardial infarction, or target vessel revascularization ( 35 ).…”

“…Chen and Chen 10.3389/fcvm.2023.1138787 that PCSK9 inhibitors could promote regression in plaque composition (33, 50). Studies are underway to determine the effects of the early implementation of PCSK9 inhibitors on plaque, blood flow, vascular inflammation, and other relevant imaging features in patients with ACS (13,15,34,35,51). PACMAN-AMI was a multicenter, double-blind, placebocontrolled, randomized trial involving 300 AMI patients with the basic treatment of high intensity statins who initiated PCSK9 inhibitors less than 24 h after an urgent PCI of the culprit lesion (15,51).…”

Ups and downs in PCSK9 inhibition in the cardiovascular arena: a review

“…Due in part to the rapid and profound reduction in LDL-C with in-hospital administration of PCSK9i, as well as challenges with attaining target LDL-C with statins alone [14], several small trials have demonstrated plaque regression and stabilization with PCSK9i. Relative to standard of care with statin with or without ezetimibe, addition of PCSK9i leads to a reduction in the lipid content, stabilization of plaque through increased thickening of the fibrinous cap, and reduction in atheroma volume [17 ▪▪ ,23 ▪▪ ,24,25,26 ▪ ,27 ▪ ,28–30,31 ▪ ] that is evident as soon as 30 days later (Table 1). These findings were confirmed in a meta-analysis that showed a consistent, significant regression, and stabilization of plaque by a variety of measurement modalities [32].…”