Routine early initiation of a PCSK9 inhibitor added to a high-intensity statin reduced LDL-cholesterol by 22% and appeared to be both safe and feasible in patients undergoing primary PCI for acute STEMI, based on findings from the EPIC-STEMI trial presented Sept. 19 during TCT 2022 and simultaneously published in EuroIntervention.

Researchers assigned 68 patients with STEMI undergoing primary PCI to early treatment with alirocumab (150 mg subcutaneously) or matching sham-control. The first injection was given before primary PCI regardless of baseline LDL level, then again at two weeks and four weeks. The primary outcome was the percent reduction in direct LDL-cholesterol up to six weeks, analyzed using a linear-mixed model.

Overall results showed high-intensity statin use was 97% and 100% in the alirocumab and sham-control groups, respectively. At a median of 45 days, the primary outcome of LDL-cholesterol decreased by 72.9% with alirocumab (2.97 mmol/L to 0.75 mmol/L) vs. 48.1% with sham-control (2.87 mmol/L to 1.30 mmol/L), for a mean between-group difference of -22.3%. Researchers noted that "more patients achieved ESC/EAS dyslipidemia guideline target LDL ≤1.4 mmol/L in the alirocumab group compared with the sham group (92.1% v 56.7%). Additionally, LDL declined slightly more rapidly in the alirocumab group within the first 24 hours compared with the sham-control with similar between-group mean values.

"Our study builds on the results of randomized trials demonstrating the clinical benefit of PCSK9 inhibitors added to statin therapy in patients with stable [coronary artery disease] or prior [acute coronary syndromes]," said Shamir R. Mehta, MD, FACC, et al. "A large trial is needed to determine if this simplified approach followed by long-term therapy improves cardiovascular outcomes in patients with acute STEMI."

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Stable Ischemic Heart Disease, Vascular Medicine, Interventions and Vascular Medicine, Chronic Angina

Keywords: Transcatheter Cardiovascular Therapeutics, TCT22, ST Elevation Myocardial Infarction, Percutaneous Coronary Intervention

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