
Eligibility for PCSK 9 Inhibitors According to American College of Cardiology (ACC) and European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) Guidelines After Acute Coronary Syndromes
Author(s) -
Gencer Baris,
Koskinas Konstantinos C.,
Räber Lorenz,
Karagiannis Alexios,
Nanchen David,
Auer Reto,
Carballo David,
Carballo Sebastian,
Klingenberg Roland,
Heg Dik,
Matter Christian M.,
Lüscher Thomas F.,
Rodondi Nicolas,
Mach François,
Windecker Stephan
Publication year - 2017
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.117.006537
Subject(s) - medicine , ezetimibe , familial hypercholesterolemia , cardiology , statin , acute coronary syndrome , pcsk9 , lipoprotein , cholesterol , myocardial infarction , ldl receptor
Background The American College of Cardiology (ACC) and European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) have recently published recommendations for the use of proprotein convertase subtilisin/kexin‐9 ( PCSK 9) inhibitors in situations of very high risk. We aim to assess in the real world the suitability of PCSK 9 inhibitors for acute coronary syndromes. Methods and Results We analyzed a prospective Swiss cohort of 2023 patients hospitalized for acute coronary syndromes between 2009 and 2014 with available data for low‐density lipoprotein cholesterol and lipid‐lowering therapy at 1 year. Clinical familial hypercholesterolemia was defined using the Dutch Lipid Clinic Network algorithm as unlikely, possible, probable, or definite. We simulated a fixed relative reduction of 24% in low‐density lipoprotein cholesterol levels at 1 year in all patients not treated with ezetimibe, irrespective of the low‐density lipoprotein cholesterol levels and statin regimen. At 1 year, 94.3% of patients were treated with statin, 5.8% with ezetimibe, and 35.8% of patients had on‐target low‐density lipoprotein cholesterol levels (<1.8 mmol/L); 25.6% met criteria for possible or probable/definite familial hypercholesterolemia. After a simulation of the lipid‐lowering effect of ezetimibe, the proportion of patients who would be eligible for PCSK 9 inhibitors at 1 year was 13.4% using American College of Cardiology criteria and 2.7% using European Society of Cardiology/European Atherosclerosis Society criteria. Patients with possible or probable/definite familial hypercholesterolemia were more eligible for PCSK 9 inhibitors compared with their non–familial hypercholesterolemia counterparts: 27.6% versus 8.8% according to American College of Cardiology criteria and 6.6% versus 1.8% according to European Society of Cardiology/European Atherosclerosis Society criteria ( P <0.001). Conclusions Recommendations made by the American College of Cardiology guidelines would lead to 5‐fold higher eligibility rates for PCSK 9 inhibitors compared to the European Society of Cardiology/European Atherosclerosis Society consensus statement in acute coronary syndrome patients.