A REAL–WORLD PROTOCOL OF EARLY USE OF TRIPLE LIPID LOWERING THERAPY WITH I–PCSK9

Abstract

Abstract Aim We evaluated the feasibility of an early triple lipid lowering therapy (LLT) with PCSK9 inhibitors in patients with acute coronary syndromes (ACS). Methods In this multicenter experience, we consecutively enrolled ACS patients from July to November 2023. The prescribed LLT was evaluated at discharge. Triple therapy with a high–intensity statin plus ezetimibe and PCSK9i was recommended in the following cases: patients already on statin or statin/ezetimibe therapy with LDL–C values > 70 mg/dl; patients not on LLT at admission with LDL–C values > 70 mg/dl and at least one of diabetes mellitus (DM), multivessel coronary artery disease (MV) or peripheral arterial disease (PAD); patients not on LLT at the time of admission and LDL–C values > 140 mg/dl even in the absence of DM, MV or PAD. A six–month follow–up was planned to determine LDL–C target attainment, compliance, side e!ects, and cardiovascular events. Results We consecutively enrolled 264 patients, 95% of whom were discharged with high–intensity statin plus ezetimibe and 29% discharged with in–hospital addition of PCSK9i (triple therapy). Of the 77 patients discharged in triple LLT, the median age was 71.4 years, 71% were male, 42% were current smokers, DM was present in 19%, and 48% had history of hypertension. The diagnosis at admission was ST–Elevation Myocardial Infarction in 66.2%, Non–ST–Elevation Myocardial Infarction in 29.5%, and unstable angina in 4.3% of cases; 63% of patients had history of coronary artery disease and 6.8% had history of peripheral artery disease (PAD); 19.6% were already on at least one statin therapy and the median LDL–C value at admission was 128 mg/dl. Conclusions In conclusion, the use of an early and strong lipid lowering approach in very high risk patients with in–hospital or at discharge PCSK9i administration is feasible and safe. The complete results of six–months follow–up and LDL–C values will be available for the congress.