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Abstract：
BACKGROUND: A high proportion of Canadian patients with acute myocardial infarction (AMI) do not achieve the threshold low-density lipoprotein cholesterol (LDL-C) levels recommended by the Canadian Cardiovascular Society in 2021. This increases the risk of subsequent atherosclerotic cardiovascular disease (ASCVD) events. Here, we assess LDL-C levels and threshold achievement among patients by lipid-lowering therapies (LLT) received post-AMI.
METHODS: A retrospective cohort study of patients identified with AMI between 2015 and 2019 was conducted using administrative health databases in Alberta, Canada. Patients were grouped by their highest-intensity LLT post-AMI (proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) + another LLT; PCSK9i alone; ezetimibe + statin; statins (high, moderate, low intensity); or ezetimibe alone), and available LDL-C levels were examined in the year before and after LLT dispense date.
RESULTS: The cohort included 15,283 patients. In patients on PCSK9i + LLT, the median [95% confidence interval (CI)] LDL-C levels decreased from 2.7 (2.3-3.4) before to 0.9 (0.5-1.2) mmol/l after treatment, the largest decrease among treatment groups. In the ezetimibe + statin and high-intensity statin groups, median (95% CI) values after treatment were 1.5 (1.5-1.6) and 1.4 (1.4-1.4) mmol/l, respectively. The proportion of patients below the 1.8 mmol/l threshold increased by 77.7% in the PSCK9i + LLT group after treatment, compared to 45.4 and 32.4% in the ezetimibe + statin and high-intensity statin groups, respectively.
CONCLUSIONS: Intensification with PCSK9i in AMI patients results in a greater proportion of patients achieving below the recommended LDL-C threshold versus statins and or ezetimibe alone. Increased focus on achieving below the LDL-C thresholds with additional LLT as required may benefit patient cardiovascular outcomes.
METHODS: A retrospective cohort study of patients identified with AMI between 2015 and 2019 was conducted using administrative health databases in Alberta, Canada. Patients were grouped by their highest-intensity LLT post-AMI (proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) + another LLT; PCSK9i alone; ezetimibe + statin; statins (high, moderate, low intensity); or ezetimibe alone), and available LDL-C levels were examined in the year before and after LLT dispense date.
RESULTS: The cohort included 15,283 patients. In patients on PCSK9i + LLT, the median [95% confidence interval (CI)] LDL-C levels decreased from 2.7 (2.3-3.4) before to 0.9 (0.5-1.2) mmol/l after treatment, the largest decrease among treatment groups. In the ezetimibe + statin and high-intensity statin groups, median (95% CI) values after treatment were 1.5 (1.5-1.6) and 1.4 (1.4-1.4) mmol/l, respectively. The proportion of patients below the 1.8 mmol/l threshold increased by 77.7% in the PSCK9i + LLT group after treatment, compared to 45.4 and 32.4% in the ezetimibe + statin and high-intensity statin groups, respectively.
CONCLUSIONS: Intensification with PCSK9i in AMI patients results in a greater proportion of patients achieving below the recommended LDL-C threshold versus statins and or ezetimibe alone. Increased focus on achieving below the LDL-C thresholds with additional LLT as required may benefit patient cardiovascular outcomes.
摘要：
背景：加拿大急性心肌梗死（AMI）患者中有很大比例未达到2021年加拿大心血管学会推荐的阈值低密度脂蛋白胆固醇（LDL-C）水平。这增加了随后的动脉粥样硬化性心血管疾病(ASCVD)事件的风险。这里,我们评估了AMI后接受降脂治疗(LLT)的患者的LDL-C水平和阈值成就.
方法：使用艾伯塔省的行政健康数据库，对2015年至2019年确定的AMI患者进行了回顾性队列研究。加拿大。患者按AMI后最高强度的LLT进行分组（前蛋白转化酶枯草杆菌蛋白酶/kexin9型抑制剂（PCSK9i）另一种LLT；单独的PCSK9i；依泽替米贝他汀类药物；他汀类药物（高，中度,低强度)；或单独使用依泽替米贝)，和可用的LDL-C水平在LLT分配日期之前和之后的一年进行了检查。
结果：该队列包括15,283名患者。在PCSK9i+LLT的患者中，中位[95%置信区间(CI)]LDL-C水平从治疗前的2.7(2.3-3.4)下降到治疗后的0.9(0.5-1.2)mmol/l,治疗组下降幅度最大。在依泽替米贝+他汀类药物和高强度他汀类药物组中，治疗后的中位数（95％CI）值分别为1.5（1.5-1.6）和1.4（1.4-1.4）mmol/l，分别。PSCK9i+LLT组治疗后低于1.8mmol/l阈值的患者比例增加了77.7%,与依泽替米贝+他汀类药物和高强度他汀类药物组的45.4%和32.4%相比，分别。
结论：与单独使用他汀类药物和/或依泽替米贝相比，在AMI患者中，PCSK9i强化导致达到推荐LDL-C阈值以下的患者比例更高。增加对达到低于LDL-C阈值的关注，并根据需要额外的LLT可能有益于患者心血管结局。
方法：使用艾伯塔省的行政健康数据库，对2015年至2019年确定的AMI患者进行了回顾性队列研究。加拿大。患者按AMI后最高强度的LLT进行分组（前蛋白转化酶枯草杆菌蛋白酶/kexin9型抑制剂（PCSK9i）另一种LLT；单独的PCSK9i；依泽替米贝他汀类药物；他汀类药物（高，中度,低强度)；或单独使用依泽替米贝)，和可用的LDL-C水平在LLT分配日期之前和之后的一年进行了检查。
结果：该队列包括15,283名患者。在PCSK9i+LLT的患者中，中位[95%置信区间(CI)]LDL-C水平从治疗前的2.7(2.3-3.4)下降到治疗后的0.9(0.5-1.2)mmol/l,治疗组下降幅度最大。在依泽替米贝+他汀类药物和高强度他汀类药物组中，治疗后的中位数（95％CI）值分别为1.5（1.5-1.6）和1.4（1.4-1.4）mmol/l，分别。PSCK9i+LLT组治疗后低于1.8mmol/l阈值的患者比例增加了77.7%,与依泽替米贝+他汀类药物和高强度他汀类药物组的45.4%和32.4%相比，分别。
结论：与单独使用他汀类药物和/或依泽替米贝相比，在AMI患者中，PCSK9i强化导致达到推荐LDL-C阈值以下的患者比例更高。增加对达到低于LDL-C阈值的关注，并根据需要额外的LLT可能有益于患者心血管结局。
