Early Application Of PCSK9 Inhibitors In The Treatment Of Acute ST-segment Elevation Myocardial Infarction

Objective:Retrospective analysis on the effect and safety of preprotein convertase subtilisin /kexin9(PCSK9)inhibitor on blood lipid and major cardiovascular events in patients with ST-segment elevation myocardial infarction(STEMI)before primary percutaneous coronary intervention(PCI).Methods:Strictly according to inclusion and exclusion criteria,135 patients with STEMI who underwent emergency PCI in our hospital from September 2020 to October 2021 were assigned into a combination treatment group(63 cases)and a conventional treatment group(72 cases).The combined treatment group was treated with Alisiumab combined with atorvastatin after surgery.The conventional treatment group was only treated with atorvastatin after surgery.Patients in both groups received standard drug treatment after surgery.The general information,blood lipid,liver and kidney function,and other indicators of the patients at admission were collected.The postoperative bleeding risk of the patients was graded according to the CRUSADE bleeding score.Adverse drug events that occurred after alirocumab injection were recorded.At both one week and one month postoperative,following analysis were performed:blood lipid change before and after the treatment,cross-group difference in blood lipid change before and after treatment,incidents of major adverse cardiovascular events,the differences between the liver and kidney function and bleeding risk classification.Results:1 There were no significant differences between the combined treatment group and the conventional treatment group in general information,blood lipid,liver and kidney function at admission,and bleeding risk classification(P>0.05).2 The LDL-C target rate was higher in the combined treatment group than in the conventional treatment group,both at one week and one month after primary PCI.One week after the emergency,the combined treatment group and conventional treatment group were compared before and after treatment,and it was found that total cholesterol(CHOL),triglyceride(TG),low density lipoprotein(LDL-C),high density lipoprotein(HDL-C)and lipoprotein a[Lp(a)] were significantly different after treatment(P<0.01).The level of apolipoprotein B(Apo B)in the combined treatment group was significantly lower than that before treatment(P<0.01),and there was no significant difference in the conventional treatment group(P>0.05).There were significant differences in CHOL,TG,LDL-C,HDL-C and Apo B between the two groups before and after treatment(P<0.01).One month after PCI,the levels of CHOL,TG,LDL-C and HDL-C in the combined treatment group were significantly lower than those in the conventional treatment group(P<0.01),while Lp(a)had no significant difference(P>0.05).Apo B in the combined treatment group was significantly lower than before treatment(P<0.01).There were significant differences in the levels of CHOL,LDL-C,HDL-C and Apo B between the combined treatment group and the conventional treatment group(P<0.01).3 The incidence of major adverse cardiovascular events 1 month after the combined treatment group was lower than that of the conventional treatment group(P< 0.01).4 There were no significant differences in aspartate aminotransferase(AST),alanine aminotransferase(ALT),creatinine(CREA),glomerular filtration rate(GFR)and bleeding risk grading between the combined treatment group and the conventional treatment group before and after treatment(P> 0.05).Conclusions:The addition of alirocumab to primary PCI in patients with STEMI rapidly reduces lipid levels and the incidence of major adverse cardiovascular events one month later.Compared with statin therapy alone,the preoperative addition of alirocumab did not increase the risk of hepatic and renal impairment or bleeding.Preoperative alirocumab treatment is safe and effective for STEMI patients,suggesting that alirocumab can be used before surgery for STEMI patients,providing new choices for the treatment of STEMI patients undergoing emergency PCI.