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Early administration of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in patients with acute coronary syndrome: a systematic review and meta-analysis.
- Source :
-
BMC cardiovascular disorders [BMC Cardiovasc Disord] 2024 Jul 30; Vol. 24 (1), pp. 395. Date of Electronic Publication: 2024 Jul 30. - Publication Year :
- 2024
-
Abstract
- Background: High-intensity statin therapy is currently recommended initial guideline therapy in ACS treatment. However, only a minority of patients are achieving LDL-C attainment goal at 6 months. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are on recommended guideline therapy post-ACS if LDL-C goal attainment is not achieved after high-intensity statin (4-6 weeks) and after the addition of ezetimibe if guideline goal attainment is not achieved after an additional 4-6 weeks. Thus, it has been recommended that PCSK9 inhibitors be considered earlier post-ACS. However, the efficacy of early PCSK9 inhibitors initiation in ACS patients remains uncertain.<br />Methods: This systematic review and meta-analysis was conducted following PRISMA guidelines. Randomized controlled trials (RCTs) and observational studies involving ACS patients who received PCSK9 inhibitors within 48 h of hospitalization were included. Common and random effects models were used to evaluate the pooled effect of early PCSK9 inhibitor administration. Nine RCTs and three cohort studies were included.<br />Results: Early PCSK9 inhibitor administration reduced the incidence of MI, ACS hospitalization, and revascularization at 6-18 months post-ACS. Although there was a drift towards reduced stroke, all-cause mortality, and cardiovascular death, no statistically significant reduction was observed. Additionally, PCSK9 inhibitors significantly enhanced lipid control at 4-12 weeks after index hospitalization.<br />Conclusion: Early PCSK9 inhibitors initiation in ACS patients reduces MACE and improves lipid profiles. While the results propose promising benefits in terms of stroke and mortality, further research with longer follow-up is required for more decisive evidence.<br /> (© 2024. The Author(s).)
- Subjects :
- Humans
Anticholesteremic Agents adverse effects
Anticholesteremic Agents administration & dosage
Anticholesteremic Agents therapeutic use
Cholesterol, LDL blood
Drug Administration Schedule
Dyslipidemias drug therapy
Dyslipidemias blood
Dyslipidemias diagnosis
Dyslipidemias mortality
Hydroxymethylglutaryl-CoA Reductase Inhibitors administration & dosage
Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use
Hydroxymethylglutaryl-CoA Reductase Inhibitors adverse effects
Myocardial Infarction mortality
Myocardial Infarction drug therapy
Myocardial Infarction diagnosis
Myocardial Revascularization
Observational Studies as Topic
Randomized Controlled Trials as Topic
Risk Factors
Serine Proteinase Inhibitors adverse effects
Serine Proteinase Inhibitors therapeutic use
Serine Proteinase Inhibitors administration & dosage
Time Factors
Treatment Outcome
Acute Coronary Syndrome drug therapy
Acute Coronary Syndrome mortality
Acute Coronary Syndrome blood
Acute Coronary Syndrome diagnosis
Biomarkers blood
PCSK9 Inhibitors
Subjects
Details
- Language :
- English
- ISSN :
- 1471-2261
- Volume :
- 24
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC cardiovascular disorders
- Publication Type :
- Academic Journal
- Accession number :
- 39080549
- Full Text :
- https://doi.org/10.1186/s12872-024-04057-w