Clinical Value Of Early Application Of Aliciumab After PCI In The Patients With Acute ST-segment Elevation Myocardial Infarction

Objective To explore the effect of early application of alisiumab on blood lipid levels and cardiovascular outcomes in patients with acute ST-segment elevation myocardial infarction.Methods A total of 108 STEMI patients admitted to our hospital from January 2022 to June 2022 were randomly divided into atorvastatin group and atorvastatin combined with PCSK9 inhibitor arisciumab group(hereafter referred to as Arisciumab group),including 60 cases in the atorvastatin group and 48 cases in the arisciumab group.After admission,ECG and myocardial enzyme examination were performed in the emergency department to confirm ST-segment elevation myocardial infarction,PCI was performed in the emergency department,and the postoperative treatment was given standard coronary artery drugs.The atorvastatin group to atorvastatin 20 mg/d treatment.In the aliciumab group,atorvastatin 20mg/d combined with aliciumab 75 mg was injected subcutaneously,once every 2 weeks,and the treatment period of both groups was 6months.General conditions of the two groups were compared,including age,sex,hypertension,diabetes,stroke,smoking,glycated hemoglobin,fasting blood glucose,blood lipid,liver and kidney function,blood routine,basic medication,criminal vascular conditions,heart function(Killip scale)and other baseline data.The changes of blood lipid,liver and kidney function,blood glucose,blood routine,reduction of low density lipoprotein,standard attainment rate,length of hospital stay and the incidence of MACE and clinical adverse cardiovascular events(including muscle-related events,neurocognitive events,injectation-site adverse reactions,and new-onset diabetes)in both groups were observed at 1 and 6 months after treatment.Results(1)Gender,age,history of hypertension,diabetes,smoking history,criminal blood vessel(LM,LAD,LCX and RCA),cardiac function rating(Killip rating),drug use,routine blood glucose in emergency admission,glycated hemoglobin,blood routine(leukocyte,hemoglobin,platelet),liver function(alanine aminotransferase,aspartic acid)of the two groups of patients There was no statistical significance in amino aminotransferase),renal function(creatinine,glomerular filtration rate)(P>0.05);There were no significant differences in liver,kidney function,blood glucose and blood image between the two groups before and after treatment(P>0.05).(2)There were no significant differences in LDL-C,HDL-C,TC,TG and Lp(a)between2 groups before medication(P>0.05).After 1 month of medication,the LDL-C and TC in aliseumab group were significantly lower than those in atorvastatin group,with statistical significance(P<0.05),but there was no statistical significance in HDL-C,TG and Lp(a)between the two groups after 1 month of medication(P>0.05).LDL-C and TC decreased by 21.11% and 8.79% in atorvastatin group after 1 month,and 50.92%and 31.04% in aliseumab group after 1 month.At 6 months after treatment,LDL-C,TC,TG and Lp(a)in aliseumab group were significantly lower than those in atorvastatin group,and the difference was statistically significant(P<0.05).After 6 months of treatment,there was no significant difference in HDL-C between the two groups(P>0.05).The reduction of LDL-C and TCl in atorvastatin group was 43.06% and22.66%,respectively,and that in aliseumab group was 69.66% and 58.70%,respectively.After treatment,TC and LDL-C in both groups were significantly and continuously decreased.The mean value of LDL-C in the aliciumab group was below 1.4 mmol/L after 1 month of treatment [(1.38±0.27)mmo],and the mean value of LDL-C in the atorvastatin group was above 1.4mmo L [(2.84±0.39)mmo L].After 6 months of treatment,the mean value of LDL-C was more than 1.4mmo L [(2.05±0.53)mmo L],indicating that the aliciumab group could rapidly reduce LDL-C and reach the standard.After 1 month of treatment,30% of patients with LDL-C<1.4mmol/L in atorvastatin group achieved the standard,48.33% of patients with LDL-C<1.4mmol/L decreased by more than 50%,91.67% of patients with LDL-C<1.4mmol/L decreased by more than 50% in aliciumab group achieved the standard,85.42% of patients with LDL-C<1.4mmol/L decreased by more than 50%.After 6 months of treatment,63.33%of atorvastatin group achieved the standard with LDL-C<1.4mmol/L,and 58.33% with LDL-C< 50% reduction.The reach rate of LDL-C<1.4mmol/L in aliciumab group was97.92%,and the reach rate of LDL-C< 50% was 91.67%.The LDL-C compliance rate in the aliciumab group was significantly higher than that in the atorvastatin group at 1month and 6 months after treatment,and the difference was statistically significant(P<0.01).(3)There was no significant difference in hospital stay of myocardial infarction between the aliciumab group and the atorvastatin group(P>0.05).The time of MACE in aliciumab group was significantly lower than that in atorvastatin group at 6 months after discharge,and the difference was statistically significant(P<0.05).There was no significant difference in clinical adverse events between the two groups(P>0.05).Conclusion In STEMI patients after PCI,the addition of PCSK9 inhibitors on the basis of statin therapy can effectively reduce the levels of LDL-C,TC,TG and Lp(a),and make LDL-C reach the standard early,which can reduce the incidence of MACE events within 6 months and significantly improve the prognosis of STEMI patients with high safety.