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In-hospital Initiation of PCSK9 Inhibitor and Short-term Lipid Profile Alteration, as well as In-hospital Mortality and Readmission Rate in Patients with Acute Myocardial Infarction


 Background Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been shown to improve cardiovascular outcomes when added to conventional statin therapy. This study aims to investigate the efficacy and safety of in-hospital initiation of PCSK9 inhibitor among patients with acute myocardial infarction(AMI) based on real-world experience.Methods and Results Data were collected from the Biobank of the First Affiliated Hospital of Xi’an Jiaotong University between January 2016 and December 2020. 7556 AMI patients were screened for eligibility. Propensity Score Match(PSM) was employed and covariates were age, sex, admission blood pressure and lipid profiles. Eligible participants were (1) propensity-matched 1:2:2 of Statin plus Evolocumab (dual therapy) vs. Statin vs. Statin plus Ezetimibe. 95 Statin plus Evolocumab users achieved significant decreased LDL level (0.92±0.62 mmol/L in the 1st month and 1.17±0.73 in the 3rd month) and a promising attainment rate of LDL(79.5% in 1st month and 80.0% in the 3rd month ) as compared to the other two groups. (2) propensity-matched 1:2:2 of Statin plus Ezetimibe Evolocumab (triple therapy) vs. Statin vs. Statin plus Ezetimibe. Similarly, 75 triple medication users achieved significantly decreased LDL levels and a promising attainment rate of LDL as compared to the other two groups. In-hospital mortality, readmission rate within 3 months were then analyzed and decreased readmission rate was observed through PCSK9i therapy.Conclusions Based on the present single-centre real-world PSM-adjusted study, PCSK9i has been effective in short-term lipid control among AMI patients. The long-term effectiveness for reducing major cardiovascular events among AMI patients based on real-world experience remains to be explored.Trial registration: The study was registered at ClinicalTrials.gov, Unique Protocol ID: 82100477-1.