Gim Dong Hyun, Choi In Young, Ki Young-Jae, Kim Hyun Kuk, Kim Sung Soo, Park Keun-Ho, Song Heesang, Choi Dong-Hyun
Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea.
Biochemistry and Molecular Biology, Chosun University School of Medicine, Gwangju, Korea.
Korean J Intern Med. 2025 May;40(3):438-448. doi: 10.3904/kjim.2024.363. Epub 2025 Apr 30.
BACKGROUND/AIMS: Proprotein-converting enzyme subtilisin-kexin type 9 (PCSK9) inhibitors act more promptly and efficiently than statins and reduce the risk of cardiovascular events in patients with acute coronary syndrome (ACS). This study aimed to assess the short-term effects of perioperative administration of a single-dose PCSK9 inhibitor in patients with ACS.
This study included 789 consecutive patients undergoing percutaneous coronary intervention (PCI) for ACS. The primary clinical endpoint was the occurrence of major adverse cardiovascular events (MACEs) within one month, including cardiac death, non-fatal myocardial infarction, unanticipated revascularization, stroke, stent thrombosis, and rehospitalization for ischemic causes or heart failure.
PCSK9 inhibitors were administered to 201 of 789 patients. MACEs occurred in eight patients (4.0%) in the treated group and 60 patients (10.2%) in the non-treated group for one month (hazard ratio 0.38, 95% confidence interval 0.18 to 0.80, p = 0.010). The benefit of PCSK9 inhibitors in terms of MACEs was greater in the subgroup of patients treated more than 1 hour before PCI than in the subgroup treated less than 1 hour before PCI or treated after PCI and in the non-treated group.
In patients undergoing PCI for ACS, the risk of MACEs was lower in those treated with perioperative single-dose PCSK9 inhibitors than in those in the untreated group. This benefit was especially noticeable in the subgroups treated > 1 hour before PCI than in those treated less than 1 hour before PCI or after PCI, regardless of the clinical presentation of ACS.
背景/目的：前蛋白转化酶枯草溶菌素9型（PCSK9）抑制剂的作用比他汀类药物更迅速、有效，可降低急性冠状动脉综合征（ACS）患者发生心血管事件的风险。本研究旨在评估围手术期单剂量PCSK9抑制剂给药对ACS患者的短期影响。
本研究纳入了789例因ACS接受经皮冠状动脉介入治疗（PCI）的连续患者。主要临床终点是1个月内发生的主要不良心血管事件（MACE），包括心源性死亡、非致命性心肌梗死、意外血运重建、中风、支架血栓形成以及因缺血原因或心力衰竭再次住院。
789例患者中有201例接受了PCSK9抑制剂治疗。治疗组1个月内有8例患者（4.0%）发生MACE，未治疗组有60例患者（10.2%）发生MACE（风险比0.38，95%置信区间0.18至0.80，p = 0.010）。在PCI术前1小时以上接受治疗的患者亚组中，PCSK9抑制剂在预防MACE方面的益处大于PCI术前1小时以内接受治疗或PCI术后接受治疗的亚组以及未治疗组。
在因ACS接受PCI的患者中，围手术期单剂量PCSK9抑制剂治疗的患者发生MACE的风险低于未治疗组。无论ACS的临床表现如何，这种益处在PCI术前1小时以上接受治疗的亚组中比在PCI术前1小时以内或术后接受治疗的亚组中更为明显。
