Impact of a Physician-led Strike Early-Strike Strong Lipid-Lowering Protocol Incorporating PCSK9 Inhibitors for Patients with Acute Myocardial Infarction.

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of atherosclerosis and thrombosis Pub Date : 2025-05-21 DOI:10.5551/jat.65731

Riku Arai, Yuta Hotsubo, Yuki Nakajima, Ran Sumida, Saki Mizobuchi, Shohei Migita, Yudai Tanaka, Koichiro Hori, Katsunori Fukumoto, Yasunari Ebuchi, Keisuke Kojima, Mitsumasa Sudo, Yasuo Okumura

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引用次数: 0

Abstract

Aims: Intensive lipid-lowering therapy is recommended for secondary prevention of cardiovascular events after acute myocardial infarction (AMI). However, the prescription rate of PCSK9 inhibitors (PCSK9is) remains low among patients not achieving low-density lipoprotein (LDL) cholesterol target levels.

Methods: A retrospective analysis was conducted on 194 patients with AMI who were discharged alive and followed up as outpatients at our institution between October 2022 and October 2024. In October 2023, we implemented the Physician-led Strike Early-Strike Strong Lipid-Lowering Protocol (Physician-led Protocol) to enhance lipid management. Patients were divided into two groups: pre-protocol (October 2022-September 2023) and post-protocol (October 2023-October 2024). Patient background characteristics, lipid-lowering therapies, and LDL cholesterol levels in the chronic phase were compared between the two groups. The outcomes included post-discharge PCSK9i initiation rates and chronic-phase LDL levels.

Results: While the prescription rates of strong statins and ezetimibe were similar between the groups, PCSK9i use was significantly higher in the post-protocol group than in the pre-protocol group (15.3% vs. 2.8%, p = 0.002). Furthermore, the chronic LDL levels were significantly lower in the post-protocol group than in the pre-protocol group (51.0 vs. 58.0 mg/dL, p = 0.007). Multivariate logistic regression showed that initial LDL levels and PCSK9i use were associated with achieving chronic LDL levels ＜55 mg/dL. Among eligible patients in the post-protocol group, 36.4% received PCSK9is.

Conclusions: The physician-led protocol increased PCSK9i prescriptions, achieving a median chronic LDL level of 51 mg/dL.

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医生主导的含PCSK9抑制剂的早期强降脂方案对急性心肌梗死患者的影响

目的：强化降脂治疗被推荐用于急性心肌梗死（AMI）后心血管事件的二级预防。然而，在未达到低密度脂蛋白（LDL）胆固醇目标水平的患者中，PCSK9抑制剂（PCSK9is）的处方率仍然很低。方法：回顾性分析2022年10月至2024年10月在我院门诊存活出院并随访的AMI患者194例。2023年10月，我们实施了医生主导的罢工早罢工强降脂协议（医生主导协议），以加强脂质管理。患者分为两组：方案前（2022年10月- 2023年9月）和方案后（2023年10月- 2024年10月）。比较两组患者背景特征、降脂疗法和慢性期LDL胆固醇水平。结果包括出院后PCSK9i起始率和慢性期LDL水平。结果：虽然两组间强效他汀类药物和依折替米布的处方率相似，但方案后组的PCSK9i使用率显著高于方案前组（15.3% vs. 2.8%, p = 0.002）。此外，方案后组的慢性LDL水平显著低于方案前组（51.0 vs. 58.0 mg/dL, p = 0.007）。多因素logistic回归显示，初始LDL水平和PCSK9i的使用与达到慢性LDL水平<55 mg/dL相关。在方案后组符合条件的患者中，36.4%的患者接受了PCSK9is。结论：医生主导的方案增加了PCSK9i处方，达到了51 mg/dL的中位慢性LDL水平。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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