Clinical Observation Of PCSK9 Inhibitor In Patients With Acute Coronary Syndrome

Background:Nowadays,one of the cornerstones of the treatment of patients with acute coronary syndrome(ACS)is still to strengthen lipid-lowering and reduce low-density lipoprotein cholesterol(LDL-C).In 2019,the American Society of Cardiology(ACC)and the American Heart Association(AHA)published the guidelines for the clinical practice management of cholesterol,and made different recommendations for the goal of blood lipid treatment according to the risk classification of ACS patients’ condition assessment.In 2020,the ACC expert group developed an expert consensus on "non statins treatment and reduction of LDL-C",which pointed out that LDL-C is the primary intervention target of lipid-lowering treatment.At present,it is found that the tolerance and safety of high-intensity statins in China are poor,and the compliance rate is low.A large number of prospective studies show that doubling the dose of statins can reduce LDL-C by about 6%on average,but the subsequent side effects are significantly increased.Therefore,in the case that the blood lipids treated with statins are still not up to the standard,the guidelines suggest that they should be combined with non statins to reduce blood lipids.Evolocumab is a monoclonal antibody that inhibits the preprotein converting enzyme subtilisin /kexin 9(PCSK9).It is produced and provided by Amgen company.Purpose:To observe the effect of PCSK9 inhibitor combined with statins on blood lipid,CRP,carotid plaque area and carotid intima thickness in patients with ACS,to observe whether it can reduce the occurrence of adverse cardiovascular events and increase the adverse drug reactions after treatment.Method:The study included patients who were hospitalized in our hospital from October2019 to may 2021 and were diagnosed with ACS after admission.After screening by inclusion and exclusion criteria,293 hospitalized patients(whether or not coronary intervention)were finally enrolled.There were 152 patients in the treatment group(3 months of combined treatment with eloyumab and statins)and 141 patients in the control group(3 months of treatment with statins alone).The general clinical data of the two groups at admission and the observation indexes of the two groups before and after treatment were collected.General clinical data include age,gender,smoking,obesity,hypertension,diabetes,and previous medication(arb/acei drugs,statins β-Receptor blockers,aspirin),whether there have been previous cardiovascular events(history of myocardial infarction,angina pectoris,coronary revascularization,atherosclerotic stroke,peripheral arterial disease,peripheral revascularization,etc.),whether interventional therapy(revascularization)has been performed during hospitalization,etc.Before and after treatment,the observed indexes of the two groups included: blood lipid,C-reactive protein(CRP),carotid intima thickness and carotid plaque area,including total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),apolipoprotein A1(ApoA1),apolipoprotein B(apo B),high-density lipoprotein(HDL),lipoprotein(a)(LP(a)).The two groups were followed up 6 months after treatment,and the indexes were compared and statistically analyzed;At the same time,the recurrence rate of major adverse cardiovascular event(MACE)(including cardiac death,myocardial infarction,revascularization,angina pectoris attack)and the incidence of adverse drug reactions after medication were compared and analyzed between the two groups through telephone follow-up Results:1.there was no significant difference in blood lipid(TC,TG,LDL-C,ApoA1,apo B,HDL,LP(a)),CRP,carotid intima thickness and carotid plaque area between the two groups before treatment(P > 0.05),indicating that the two groups were comparable.2.there was no significant difference in ApoA1 and HDL between the two groups after treatment(P > 0.05);However,in terms of TC,TG,LDL-C,apo B,LP(a),CRP,carotid intima thickness and carotid ultrasound plaque area,the treatment group had a more significant decrease than the control group,and the curative effect was better.The difference was statistically significant(P < 0.05).3.after telephone follow-up,the recurrence rate of mace events(including cardiac death,myocardial infarction,revascularization and angina pectoris attack)in the treatment group was significantly lower than that in the control group(P < 0.05).4.there was no significant difference in adverse drug reactions between the treatment group and the control group(P > 0.05).Conclusion:PCSK9 inhibitor(eloyumab)can significantly reduce blood lipids(TC,TG,LDL-C,apo B,LP(a));In PCSK9 inhibitor group,carotid intima thickness was thinner and carotid plaque area was smaller;It can significantly reduce the inflammatory index CRP;It can reduce the recurrence rate of mace events after medication;No increase in adverse reactions was observed and the safety was good.