Eligibility for PCSK9 Inhibitors According to American College of Cardiology (ACC) and European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) Guidelines After Acute Coronary Syndromes.

Abstract

BACKGROUND:

The American College of Cardiology (ACC) and European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) have recently published recommendations for the use of proprotein convertase subtilisin/kexin-9 (PCSK9) inhibitors in situations of very high risk. We aim to assess in the real world the suitability of PCSK9 inhibitors for acute coronary syndromes.

METHODS AND RESULTS:

We analyzed a prospective Swiss cohort of 2023 patients hospitalized for acute coronary syndromes between 2009 and 2014 with available data for low-density lipoprotein cholesterol and lipid-lowering therapy at 1 year. Clinical familial hypercholesterolemia was defined using the Dutch Lipid Clinic Network algorithm as unlikely, possible, probable, or definite. We simulated a fixed relative reduction of 24% in low-density lipoprotein cholesterol levels at 1 year in all patients not treated with ezetimibe, irrespective of the low-density lipoprotein cholesterol levels and statin regimen. At 1 year, 94.3% of patients were treated with statin, 5.8% with ezetimibe, and 35.8% of patients had on-target low-density lipoprotein cholesterol levels (<1.8 mmol/L); 25.6% met criteria for possible or probable/definite familial hypercholesterolemia. After a simulation of the lipid-lowering effect of ezetimibe, the proportion of patients who would be eligible for PCSK9 inhibitors at 1 year was 13.4% using American College of Cardiology criteria and 2.7% using European Society of Cardiology/European Atherosclerosis Society criteria. Patients with possible or probable/definite familial hypercholesterolemia were more eligible for PCSK9 inhibitors compared with their non-familial hypercholesterolemia counterparts: 27.6% versus 8.8% according to American College of Cardiology criteria and 6.6% versus 1.8% according to European Society of Cardiology/European Atherosclerosis Society criteria (P<0.001).

CONCLUSIONS:

Recommendations made by the American College of Cardiology guidelines would lead to 5-fold higher eligibility rates for PCSK9 inhibitors compared to the European Society of Cardiology/European Atherosclerosis Society consensus statement in acute coronary syndrome patients.

• Authors: Baris Gencer, Konstantinos C Koskinas, Lorenz Räber, Alexios Karagiannis, David Nanchen, Reto Auer, David Carballo, Sebastian Carballo, Roland Klingenberg, Dik Heg, Christian M Matter, Thomas F Lüscher, Nicolas Rodondi, François Mach, Stephan Windecker
• Journal: Journal of the American Heart Association (J Am Heart Assoc) Vol. 6 Issue 11 (Nov 09 2017) ISSN: 2047-9980 [Electronic] England
• PMID: 29122809 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Chemical References

• Anticholesteremic Agents
• Cholesterol, LDL
• PCSK9 Inhibitors
• PCSK9 protein, human
• Ezetimibe

Topics

• Acute Coronary Syndrome (blood, drug therapy)
• Anticholesteremic Agents (administration & dosage)
• Apoptosis
• Cardiology
• Cholesterol, LDL (blood)
• Dose-Response Relationship, Drug
• Eligibility Determination (methods)
• Europe
• Ezetimibe (administration & dosage)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• PCSK9 Inhibitors
• Practice Guidelines as Topic
• Prospective Studies
• Societies, Medical
• Time Factors
• Treatment Outcome
• United States