Guideline LDL-C Threshold Achievement in Acute Myocardial Infarction Patients: A Real-World Evidence Study Demonstrating the Impact of Treatment Intensification with PCSK9i (jan, 10.1007/s40119-022-00300-7, 2023)

被引:1
作者
Mackinnon, Erin S. [1 ]
Har, Bryan [2 ]
Champsi, Salimah [1 ]
Wani, Rajvi J. [1 ]
Geyer, Lee [3 ]
Shaw, Eileen [3 ]
Farris, Megan S. [3 ]
Anderson, Todd J. [2 ]
机构
[1] Amgen Canada Inc, 6775 Financial Dr 100, Mississauga, ON L5N 0A4, Canada
[2] Univ Calgary, Libin Cardiovasc Inst, Cumming Sch Med, Calgary, AB, Canada
[3] Medlior Hlth Outcomes Res Ltd, Calgary, AB, Canada
关键词
Acute myocardial infarction; Lipid-lowering therapy; Low-density lipoprotein cholesterol; Proprotein convertase subtilisin/kexin type 9 inhibitors; Real-world evidence;
D O I
10.1007/s40119-023-00310-z
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction: A high proportion of Canadian patients with acute myocardial infarction (AMI) do not achieve the threshold low-density lipoprotein cholesterol (LDL-C) levels recommended by the Canadian Cardiovascular Society in 2021. This increases the risk of subsequent atherosclerotic cardiovascular disease (ASCVD) events. Here, we assess LDL-C levels and threshold achievement among patients by lipid-lowering therapies (LLT) received post-AMI. Methods: A retrospective cohort study of patients identified with AMI between 2015 and 2019 was conducted using administrative health databases in Alberta, Canada. Patients were grouped by their highest-intensity LLT post-AMI (proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) + another LLT; PCSK9i alone; ezetimibe + statin; statins (high, moderate, low intensity); or ezetimibe alone), and available LDL-C levels were examined in the year before and after LLT dispense date. Results: The cohort included 15,283 patients. In patients on PCSK9i + LLT, the median [95% confidence interval (CI)] LDL-C levels decreased from 2.7 (2.3–3.4) before to 0.9 (0.5–1.2) mmol/l after treatment, the largest decrease among treatment groups. In the ezetimibe + statin and high-intensity statin groups, median (95% CI) values after treatment were 1.5 (1.5–1.6) and 1.4 (1.4–1.4) mmol/l, respectively. The proportion of patients below the 1.8 mmol/l threshold increased by 77.7% in the PSCK9i + LLT group after treatment, compared to 45.4 and 32.4% in the ezetimibe + statin and high-intensity statin groups, respectively. Conclusions: Intensification with PCSK9i in AMI patients results in a greater proportion of patients achieving below the recommended LDL-C threshold versus statins and or ezetimibe alone. Increased focus on achieving below the LDL-C thresholds with additional LLT as required may benefit patient cardiovascular outcomes. © 2022, The Author(s).
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页码:339 / 339
页数:1
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