D'Andrea Davide, Capone Valentina, Bellis Alessandro, Castaldo Rossana, Franzese Monica, Carpinella Gerardo, Furbatto Fulvio, La Rocca Fulvio, Marsico Fabio, Marfella Raffaele, Paolisso Giuseppe, Paolisso Pasquale, Fumagalli Carlo, Cappiello Maurizio, Bossone Eduardo, Mauro Ciro
Unità Operativa Complessa Cardiologia con UTIC ed Emodinamica, Dipartimento Reti Tempo-Dipendenti, Azienda Ospedaliera "Antonio Cardarelli", Via A. Cardarelli n. 9, 80131 Napoli, Italy.
Bioinformatics Lab, SDN-SYNLAB, IRCCS SDN Spa, 80143 Napoli, Italy.
J Clin Med. 2025 Apr 26;14(9):2992. doi: 10.3390/jcm14092992.
: The "fast track" addition (within 48 h) of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) to the optimized oral lipid-lowering therapy (LLT) during hospitalization for acute coronary syndrome (ACS) has been shown to rapidly achieve the low-density lipoprotein cholesterol (LDL-C) therapeutic targets. However, so far, its efficacy in real-world settings remains understudied. : We retrospectively analyzed 128 ACS patients treated at our center, comparing "PCSK9i fast track" use within 48 h to standard "stepwise" LLT. Lipid levels and incidence of major adverse cardiovascular events (MACEs) were evaluated at 30 and 180 days. : The "PCSK9i fast track" group achieved significantly lower LDL-C levels at 30 days (41.5 ± 27.5 vs. 85.6 ± 35.9 mg/dL, < 0.001) and 180 days (29.6 ± 21.0 vs. 59.0 ± 32.4 mg/dL, < 0.001). Recommended LDL-C targets (<55 mg/dL) were met by 88.3% of the "PCSK9i fast track" group at 180 days, compared with 61.9% of controls ( < 0.001). No significant differences in MACEs were observed between groups. No adverse effects from PCSK9i use were noted. : The "PCSK9i fast track" strategy was safe and effective in achieving LDL-C targets more rapidly than conventional approaches in real-world ACS patients.
在急性冠状动脉综合征（ACS）住院期间，于优化的口服降脂治疗（LLT）基础上“快速通道”添加（48小时内）前蛋白转化酶枯草溶菌素/kexin 9型抑制剂（PCSK9i）已被证明能迅速实现低密度脂蛋白胆固醇（LDL-C）治疗目标。然而，到目前为止，其在现实环境中的疗效仍未得到充分研究。我们回顾性分析了在本中心接受治疗的128例ACS患者，比较了48小时内使用“PCSK9i快速通道”与标准“逐步”LLT的情况。在30天和180天时评估血脂水平和主要不良心血管事件（MACE）的发生率。“PCSK9i快速通道”组在30天（41.5±27.5对85.6±35.9mg/dL，<0.001）和180天（29.6±21.0对59.0±32.4mg/dL，<0.001）时LDL-C水平显著降低。180天时，“PCSK9i快速通道”组88.3%的患者达到了推荐的LDL-C目标（<55mg/dL），而对照组为61.9%（<0.001）。两组之间未观察到MACE有显著差异。未发现使用PCSK9i的不良反应。在现实世界的ACS患者中，“PCSK9i快速通道”策略在比传统方法更快实现LDL-C目标方面是安全有效的。
