P5445PCSK9 and 6-month Left Ventricular Ejection Fraction after ST-segment Elevation Myocardial Infarction. A Pilot Study

Abstract

Abstract Background Proprotein convertase subtilisin/kexin type 9 (PCSK9) has emerged as a therapeutic target for reducing plasma LDL. Beyond lipid control, recent findings suggest a deleterious effect of this protein in the pathogenesis of post-myocardial infarction left ventricle remodeling and heart failure-related complications. The aim of this work was to assess the relationship between circulating PCSK9 and 6-month cardiac magnetic resonance (CMR) imaging-derived left ventricle ejection fraction (LVEF) after a first ST-segment elevation myocardial infarction (STEMI). Methods We prospectively evaluated 40 patients with a first STEMI treated with primary percutaneous coronary intervention (PPCI) and LVEF<50% in which PCSK9 was measured 24h post-reperfusion. All patients underwent CMR imaging 1 week and 6 months after STEMI. The association between serum PCSK9 and 6-month LVEF was evaluated by ANCOVA. The following covariates were included in the final model; 1-week CMR-derived LVEF, age, gender, 1-week CMR-infarct size, plasma suppression of tumorigenicity-2 (ST2), low density lipoprotein-cholesterol, ante treatment with statins. Results The mean age of the sample was 60±12 years and 33 patients (82.5%) were male. Mean 1-week and 6-month LVEF were 41±7% and 48±10%, respectively. The mean±SD of PCSK9 was 1.93±0.38 U/mL. PCSK9 values were inversely related with 6-month LVEF (r=−0.35, p=0.028). The mean values of PCSK9 were significantly higher in patients with LVEF<50% at 6 months (2.06±0.29 vs. 1.80±0.41 U/mL, p=0.028). After a multivariate adjustment, circulating PCSK9 remained significant and inversely associated with 6-month LVEF (p=0.001). Figure 1 Conclusions In patients with a first STEMI treated with PCCI and reduced ejection fraction, circulating PCSK9 was associated with lower LVEF at 6 months.