Effects Of PCSK9 Inhibitors On Lipids And Prognosis In Patients With ACS

Objective: As an extremely high-risk patient,acute coronary syndrome(ACS)is characteristics by high basic low density lipoprotein(LDL-C)level at admission and difficult to reach the standard of conventional lipid-lowering drug therapy,which is closely related to poor prognosis.PCSK9 inhibitors not only have a strong lipid-lowering effect,but also can reduce cardiovascular events.However,previous studies have not clarified the relationship between PCSK9 inhibitors and target vessel revascularization(TVR)and non-target vessel revascularization(non-TVR).Therefore,the study aims to analyze the effects of PCSK9 inhibitors on lipid,TVR and non-TVR in patients with ACS,and to provide more clinical data for the application of PCSK9 inhibitors in patients with ACS.Methods: In this study,140 patients with ACS who were admitted to our hospital from July 2017 to July 2020 were retrospectively enrolled and divided into three groups according to the lipidlowering strategies: statin alone group(n=56),statin combined with ezetimibe group(n=56),and statin plus ezetimibe plus PCSK9 inhibitor group(n=28).The level of LDL-C,total cholesterol(TC),triglyceride(TG)and high density lipoprotein(HDL-C)in 3 groups before and after treatment was analyzed,and the percentage change of lipid in each group compared with baseline was compared.TVR,non-TVR,in-stent restenosis(ISR)rate,MACE and adverse reactions were counted.Results: The analysis showed that the average LDL-C and TC levels after treatment in all three groups were lower than before(P < 0.05),and the percentage reduction of LDL-C from baseline in the PCSK9 inhibitor group was more obvious than the other two groups,while there was no significant difference in the levels of TG and HDL-C in the three groups before and after treatment(P > 0.05).The non-TVR rate in the PCSK9 inhibitor group and ezetimibe group was lower than that in the statins group(P < 0.05),but there was no difference between the PCSK9 inhibitor group and ezetimibe group(P > 0.05).There was no difference in the rate of TVR and ISR among the three groups(P > 0.05).The incidence of MACE in ezetimibe group and PCSK9 inhibitor group was lower than that in statins group(P < 0.05),while there was no statistical significance between ezetimibe group and PCSK9 inhibitor group(P > 0.05),but numerically the incidence of MACE in the PCSK9 inhibitor group was lower than ezetimibe group.No serious adverse reactions were found in the three groups during follow-up.Conclusions: Triple lipid-lowering strategies containing PCSK9 inhibitors have a stronger lipidlowering effect and can further reduce LDL-C levels in patients with ACS.Early and short-term application of PCSK9 inhibitors on the basis of statins and ezetimibe can reduce the incidence of non-TVR and MACE in patients with ACS,thus improving the prognosis,and it has good safety.