Peri-event plasma PCSK9 and hsCRP after an acute myocardial infarction correlate with early deterioration of left ventricular ejection fraction: a cohort study

Abstract

Background It is important to identify patients at increased risk of worsening of left ventricular ejection fraction (LVEF) after a myocardial infarction (MI). We aimed to identify the association of various potential biomarkers with LVEF impairment after an MI in South American patients. Methods We studied adult patients admitted to a University Hospital and diagnosed with an acute MI. Plasma concentrations of high-sensitivity C-reactive protein (hsCRP), proprotein convertase subtilisin/kexin type 9 (PCSK9), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and heart-type fatty-acid-binding protein (FABP3) were determined in samples drawn shortly after the event. Participants had a follow-up visit at least 45 days after the event. The primary endpoint was defined as any decline in LVEF at follow-up relative to baseline. Results The study included 106 patients (77.4% men, 22.6% women), mean age was 64.1, mean baseline LVEF was 56.6, 19% had a prior MI. We obtained a follow-up evaluation in 100 (94.4%) of participants, mean follow-up time was 163 days. There was a significant correlation between baseline PCSK9 and hsCRP (r = 0.39, p < 0.001). Baseline hsCRP concentrations were higher in patients who developed the endpoint than in those who did not (32.1 versus 21.2 mg/L, p = 0.066). After multivariate adjustment, baseline PCSK9, male sex and age were significantly associated with impairment in LVEF. The absolute change in LVEF was inversely correlated with baseline hsCRP (standardized coefficient = − 0.246, p = 0.004). Conclusion High plasma levels of PCSK9 and hsCRP were associated with early decreases in LVEF after an MI in Latin American patients.

Proteome-wide mendelian randomization investigates potential associations in heart failure and its etiology: emphasis on PCSK9

“…Likewise, a recent observational study identified a correlation between circulating PCSK9 levels and left ventricular ejection fraction (LVEF) after MI [ 12 , 13 ]. Furthermore, another observational study, which included a significant proportion of patients with IHD, established a link between PCSK9 and the prognosis of HF [ 14 ]. Taken together, our proteome-wide MR results and these previous findings indicate the involvement of PCSK9 in the development of ischemic HF.…”

“…In the BIOSTAT-CHF cohort, it was observed that circulating PCSK9 levels were notably elevated in HF patients, correlating positive correlation with the risk of mortality in this population [ 12 ]. Additionally, other observational studies have independently established a link between circulating PCSK9 levels and a diminished left ventricular ejection fraction (LVEF) following myocardial infarction (MI) [ 13 , 14 ]. These findings suggest the potential of PCSK9 as a viable therapeutic target for HF.…”

Effect of PCSK9 on atherosclerotic cardiovascular diseases and its mechanisms: Focus on immune regulation

“…In the FOURIER study, the reduction of absolute occurrence risk of the endpoint events after using evolocumab in stable atherosclerotic patients with previous myocardial infarction was three times as much as in patients without previous myocardial infarction (137,138). Similarly, in the ODYSSEY OUTCOMES study, the use of alirocumab in addition to statin treatment significantly reduced the risk of MACEs and death in patients with ACS, which is more significant in patients with previous myocardial infarction (139). The level of plasma PCSK9 is positively correlated with hs-CRP in myocardial infarction patients (140).…”