Eligibility for PCSK-9 inhibitors treatment in acute coronary syndrome, chronic coronary artery disease and outpatient dyslipidemic patients

Vlachopoulos, Charalambos; Dima, Ioanna; Soulis, Dimitrios; Terentes‐Printzios, Dimitrios; Skoumas, Ioannis; Aznaouridis, Konstantinos; Solomou, E; Richter, Dimitrios J; Tousoulis, Dimitrios

doi:10.1016/j.atherosclerosis.2020.04.024

Cited by 5 publications

(3 citation statements)

References 33 publications

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“…This beneficial effect is largely independent of the mechanism for achieving reduction of LDL-C. Nevertheless, despite the availability of a range of different LLT options, either alone or in combination, optimal control of LDL-C is challenging [ 10 , 11 ], especially in patients at the highest risk for CVD [ [12] , [13] , [14] ]. As one might expect, the lower the target in patients at the highest risk, the harder to achieve such a target.…”

Section: Discussionmentioning

confidence: 99%

Real-world data on treatment patterns in at least high cardiovascular risk patients on dual and triple lipid lowering therapy in a Hellenic nationwide e-prescription database

Terentes-Printzios,

Dima,

Benardos

et al. 2024

International Journal of Cardiology Cardiovascular Risk and Pre

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Section: Discussionmentioning

confidence: 99%

Real-world data on treatment patterns in at least high cardiovascular risk patients on dual and triple lipid lowering therapy in a Hellenic nationwide e-prescription database

Terentes-Printzios,

Dima,

Benardos

et al. 2024

International Journal of Cardiology Cardiovascular Risk and Pre

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“…Patients with coronary artery disease who were prospectively enrolled in a large cohort assessing eligibility for proprotein convertase subtilisin–kexin Type 9 inhibitor treatment 14 and underwent coronary angiography in ‘Hippokration’ General Hospital between October 2018 and December 2019 were considered for enrolment in this study. Patients referred for coronary artery bypass graft (CABG) surgery after coronary angiography were excluded from this analysis.…”

Section: Methodsmentioning

confidence: 99%

Prognostic role of discordance between quantitative flow ratio and visual estimation in revascularization guidance

Terentes-Printzios,

Oikonomou,

Gkini

et al. 2023

European Heart Journal Open

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Aims Revascularization guided by functional severity has presented improved outcomes compared with visual angiographic guidance. Quantitative flow ratio (QFR) is a reliable angiography-based method for functional assessment. We sought to investigate the prognostic value of discordance between QFR and visual estimation in coronary revascularization guidance. Methods and results We performed offline QFR analysis on all-comers undergoing coronary angiography. Vessels with calculated QFR were divided into four groups based on the decision to perform or defer percutaneous coronary intervention (PCI) and on the QFR result, i.e.: Group A (PCI−, QFR > 0.8); Group B (PCI+, QFR ≤ 0.8); Group C (PCI+, QFR > 0.8); Group D (PCI−, QFR ≤ 0.8). Patients with at least one vessel falling within the disagreement groups formed the discordance group, whereas the remaining patients formed the concordance group. The primary endpoint was the composite endpoint of cardiovascular death, myocardial infarction, and ischaemia-driven revascularization. Overall, 546 patients were included in the study. Discordance between QFR and visual estimation was found in 26.2% of patients. After a median follow-up period of 2.5 years, the discordance group had a significantly higher rate of the composite outcome (hazard ratio: 3.34, 95% confidence interval 1.99–5.60, P < 0.001). Both disagreement vessel Groups C and D were associated with increased cardiovascular risk compared with agreement Groups A and B. Conclusion Discordance between QFR and visual estimation in revascularization guidance was associated with a worse long-term prognosis. Our results highlight the importance of proper patient selection for intervention and the need to avoid improper stent implantations when not dictated by a comprehensive functional assessment.

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“…However, it is important to note that recent studies showed that a majority of patients are expected to meet LDL-C targets with ezetimibe/statin combinations. According to models, up to 85% of patients postacute coronary syndrome (ACS) and 81% of patients with dyslipidemia or coronary artery disease would be unlikely to meet the most recent criteria for triple therapy with a PCSK9 inhibitor; therefore, the focus should remain on combinations of ezetimibe and statins [18,20,21].…”

Section: Combination Treatments: Evidence Supporting Statin and Ezetimibe Combinationmentioning

confidence: 99%

Is it Time for Single-Pill Combinations in Dyslipidemia?

Schiele

Isla

Arca

et al. 2021

Am J Cardiovasc Drugs

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Despite the availability of lipid-lowering therapies (LLTs) that are safe and effective, the overall rate of low-density lipoprotein cholesterol (LDL-C) control at a population level in real-life studies is low. Higher-intensity treatment, earlier intervention, and longer-term treatment have all been shown to improve outcomes. However, in clinical practice, actual exposure to LLT is a product of the duration and intensity of, and adherence to, the treatment. To increase exposure to LLTs, the European Society of Cardiology guidelines recommended a stepwise optimization of LLTs by increasing statin intensity to the maximally tolerated dose, with subsequent addition of ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. Evidence from randomized controlled trials performed in a range of patients suggested that adding ezetimibe to statins rather than doubling the statin dose resulted in significantly more patients at LDL-C goal and significantly fewer patients discontinuing treatment because of adverse events. In addition, data showed that combination treatments effectively increased exposure to LLT. Despite these data and recommendations, optimization of LLT is often limited to increasing statin dose. Therapeutic inertia and poor treatment adherence are significant and prevalent barriers to increasing treatment exposure. They are known to be influenced by pill burden and complexity of treatment. Single-pill combinations provide a strategic approach that supports the intensification of treatment without increasing pill burden or treatment complexity. Single-pill combinations, compared with free associations, have been shown to increase the adherence to LLT and the percentage of patients at LDL-C goal.

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Eligibility for PCSK-9 inhibitors treatment in acute coronary syndrome, chronic coronary artery disease and outpatient dyslipidemic patients

Cited by 5 publications

References 33 publications

Real-world data on treatment patterns in at least high cardiovascular risk patients on dual and triple lipid lowering therapy in a Hellenic nationwide e-prescription database

Real-world data on treatment patterns in at least high cardiovascular risk patients on dual and triple lipid lowering therapy in a Hellenic nationwide e-prescription database

Prognostic role of discordance between quantitative flow ratio and visual estimation in revascularization guidance

Is it Time for Single-Pill Combinations in Dyslipidemia?

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