The benefits of PCSK9 inhibitors in patients with acute coronary syndrome: a systematic review and meta-analysis

Abstract

Abstract Background Proprotein convertase subtilisin/kexin 9 (PSCK9) inhibitors have been beneficial for many patients with hyperlipidemia. The objective of this study was to investigate the benefit of PSCK9 inhibitors in patients with acute coronary syndrome (ACS). Methods We systematically searched PubMed, EMBASE, and Cochrane Clinical Trials (published before January 2023; no language restriction) to compare the treatment of patients with ACS using PCSK9 inhibitors and placebo. The primary end points were major adverse cardiovascular events, nonfatal myocardial infarction, cardiogenic death, stroke, hospitalization for recurrent ACS, and coronary revascularization. Fixed- or random-effects models were used to assess the aggregated data. Results Of the 1686 identified studies, 5 were eligible and included in our analysis (of a total of 38,005 participants, 18,609 cases were placed in the PCSK9 inhibitor treatment group and 19,396 cases in the placebo group). Compared with the placebo group, PCSK9 inhibitors significantly reduced the major adverse cardiovascular events (odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.77–0.88; P < 0.00001) for patients following ACS. The incidence of nonfatal myocardial infarction (relative risk: 0.80; 95% CI: 0.74–0.87; P < 0.00001), cardiovascular death (OR: 0.96; 95% CI: 0.83–1.10; P = 0.56), stroke (OR: 0.74; 95% CI: 0.63–0.88; P = 0.0007), hospitalization for recurrent ACS (OR: 0.57; 95% CI: 0.40–0.83; P = 0.003), or coronary revascularization (OR: 0.82; 95% CI: 0.76–0.88; P < 0.00001) all demonstrated a significant decrease in the comparison between the 2 groups. Conclusion This meta-analysis demonstrated that treatment with PCSK9 inhibitors in patients with ACS reduced the probability of multiple cardiovascular events and improved patient prognosis.