McKinley E C, Bittner V A, Brown T M, Chen L, Colantonio L D, Exter J, Orroth K K, Reading S R, Rosenson R S, Muntner P
Department of Epidemiology, University of Alabama at Birmingham, Birmingham AL, United States.
Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham AL, United States.
J Clin Lipidol. 2022 Jan-Feb;16(1):75-82. doi: 10.1016/j.jacl.2021.11.001. Epub 2021 Nov 7.
Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) lower atherosclerotic cardiovascular disease (ASCVD) event risk.
Analyze patient characteristics associated with time to PCSK9i initiation following an acute myocardial infarction (AMI).
We analyzed characteristics of patients ≥21 years of age in the Marketscan or Medicare databases who initiated a PCSK9i 0-89 days, 90-179 days, or 180-365 days after an AMI between July 2015 and December 2018 (n=1,705). We estimated the cumulative incidence of recurrent ASCVD events before PCSK9i initiation.
Overall, 42%, 25%, and 33% of patients who initiated a PCSK9i did so 0-89 days, 90-179 days, and 180-365 days following AMI hospital discharge, respectively. Taking ezetimibe prior to AMI hospitalization and initiating ezetimibe within 30 days after AMI hospital discharge were each associated with a higher likelihood of PCSK9i initiation in the 0-89 days versus 180-365 days post-discharge (adjusted odds ratio [OR] 1.83, 95% confidence interval [95%CI] 1.35-2.49 and 1.76, 95%CI 1.11-2.80, respectively). Statin use before and statin initiation within 30 days after AMI hospitalization were associated with a lower likelihood of PCSK9i initiation 0-89 days versus 180-365 days post-discharge (adjusted OR 0.64, 95%CI 0.49-0.84 and 0.39, 95%CI 0.28-0.54, respectively). Overall, 8.0%, 10.5%, and 12.5% of patients had an ASCVD event at 90, 180, and 365 days following AMI hospital discharge and before initiating a PCSK9i, respectively.
Among patients initiating a PCSK9i after AMI, a low proportion did so within 89 days of hospital discharge. Many patients had a recurrent ASCVD event before treatment initiation.
前蛋白转化酶枯草溶菌素/kexin 9型抑制剂（PCSK9i）可降低动脉粥样硬化性心血管疾病（ASCVD）事件风险。
分析急性心肌梗死（AMI）后开始使用PCSK9i的时间相关的患者特征。
我们分析了2015年7月至2018年12月期间在Marketscan或医疗保险数据库中年龄≥21岁、在AMI后0 - 89天、90 - 179天或180 - 365天开始使用PCSK9i的患者特征（n = 1705）。我们估计了开始使用PCSK9i之前复发性ASCVD事件的累积发生率。
总体而言，在AMI出院后0 - 89天、90 - 179天和180 - 365天开始使用PCSK9i的患者分别占42%、25%和33%。在AMI住院前服用依折麦布以及在AMI出院后30天内开始使用依折麦布，与出院后0 - 89天相比，在180 - 365天开始使用PCSK9i的可能性更高（调整后的优势比[OR]分别为1.83，95%置信区间[95%CI]为1.35 - 2.49和1.76，95%CI为1.11 - 2.80）。在AMI住院前使用他汀类药物以及在AMI住院后30天内开始使用他汀类药物，与出院后0 - 89天相比，在180 - 365天开始使用PCSK9i的可能性更低（调整后的OR分别为0.64，95%CI为0.49 - 0.84和0.39，95%CI为0.28 - 0.54）。总体而言，分别有8.0%、10.5%和12.5%的患者在AMI出院后90天、180天和365天且在开始使用PCSK9i之前发生了ASCVD事件。
在AMI后开始使用PCSK9i的患者中，出院后89天内开始使用的比例较低。许多患者在开始治疗前发生了复发性ASCVD事件。
