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Nasso G, Larosa C, Bartolomucci F, Brigiani MS, Contegiacomo G, Demola MA, Vignaroli W, Tripoli A, Girasoli C, Lisco R, Trivigno M, Tunzi RM, Loizzo T, Hila D, Franchino R, Amodeo V, Ventra S, Diaferia G, Schinco G, Agrò FE, Zingaro M, Rosa I, Lorusso R, Del Prete A, Santarpino G, Speziale G. Safety and Efficacy of PCSK9 Inhibitors in Patients with Acute Coronary Syndrome Who Underwent Coronary Artery Bypass Grafts: A Comparative Retrospective Analysis. J Clin Med 2024; 13:907. [PMID: 38337601 PMCID: PMC10856256 DOI: 10.3390/jcm13030907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
Background. The in-hospital reduction in low-density lipoprotein cholesterol (LDL-C) levels following acute coronary syndrome (ACS) is recommended in the current clinical guidelines. However, the efficacy of proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors in those patients undergoing coronary artery bypass graft (CABG) has never been demonstrated. Methods. From January 2022 to July 2023, we retrospectively analyzed 74 ACS patients characterized by higher LDL-C levels than guideline targets and who underwent coronary bypass surgery. In the first period (January 2022-January 2023), the patients increased their statin dosage and/or added Ezetimibe (Group STEZE, 43 patients). At a later time (February 2023-July 2023), the patients received not only statins and Ezetimibe but also Evolocumab 140 mg every 2 weeks starting as early as possible (Group STEVO, 31 patients). After one and three months post-discharge, the patients underwent clinical and laboratory controls with an evaluation of the efficacy lipid measurements and every adverse event. Results. The two groups did not differ in terms of preoperative risk factors and Euroscore II (STEVO: 2.14 ± 0.75 vs. STEZE: 2.05 ± 0.6, p = 0.29). Also, there was no difference between the groups in terms of ACS (ST-, Instable angina, or NSTE) and time of symptoms onset regarding total cholesterol, LDL-C, and HDL-C trends from the preprocedural period to 3-month follow-up, but there was a more significant reduction in LDL-C and total cholesterol in the STEVO group (p = 0.01 and p = 0.04, respectively) and no difference in HDL-C rise (p = 0.12). No deaths were reported. In three STEZE group patients, angina recurrence posed the need for percutaneous re-revascularization. No STEVO patients developed significant adverse events. The statistical difference in these serious events, 7% in STEZE vs. 0% in STEVO, was not significant (p = 0.26). Conclusions. Evolocumab initiated "as soon as possible" in ACS patients submitted to CABG with high-intensity statin therapy and Ezetimibe was well tolerated and resulted in a substantial and significant reduction in LDL-C levels at discharge, 1 month, and 3 months. This result is associated with a reduction but without a statistical difference between groups.
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Affiliation(s)
- Giuseppe Nasso
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (M.S.B.); (G.C.); (M.A.D.); (W.V.); (A.T.); (C.G.); (R.L.); (M.T.); (R.M.T.); (T.L.); (D.H.); (R.F.); (S.V.); (G.S.)
| | - Claudio Larosa
- Department of Cardiology, Hospital of Andria, 76123 Andria, Italy; (C.L.); (F.B.); (M.Z.); (I.R.)
| | - Francesco Bartolomucci
- Department of Cardiology, Hospital of Andria, 76123 Andria, Italy; (C.L.); (F.B.); (M.Z.); (I.R.)
| | - Mario Siro Brigiani
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (M.S.B.); (G.C.); (M.A.D.); (W.V.); (A.T.); (C.G.); (R.L.); (M.T.); (R.M.T.); (T.L.); (D.H.); (R.F.); (S.V.); (G.S.)
| | - Gaetano Contegiacomo
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (M.S.B.); (G.C.); (M.A.D.); (W.V.); (A.T.); (C.G.); (R.L.); (M.T.); (R.M.T.); (T.L.); (D.H.); (R.F.); (S.V.); (G.S.)
| | - Maria Antonietta Demola
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (M.S.B.); (G.C.); (M.A.D.); (W.V.); (A.T.); (C.G.); (R.L.); (M.T.); (R.M.T.); (T.L.); (D.H.); (R.F.); (S.V.); (G.S.)
| | - Walter Vignaroli
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (M.S.B.); (G.C.); (M.A.D.); (W.V.); (A.T.); (C.G.); (R.L.); (M.T.); (R.M.T.); (T.L.); (D.H.); (R.F.); (S.V.); (G.S.)
| | - Alessandra Tripoli
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (M.S.B.); (G.C.); (M.A.D.); (W.V.); (A.T.); (C.G.); (R.L.); (M.T.); (R.M.T.); (T.L.); (D.H.); (R.F.); (S.V.); (G.S.)
| | - Cataldo Girasoli
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (M.S.B.); (G.C.); (M.A.D.); (W.V.); (A.T.); (C.G.); (R.L.); (M.T.); (R.M.T.); (T.L.); (D.H.); (R.F.); (S.V.); (G.S.)
| | - Rosanna Lisco
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (M.S.B.); (G.C.); (M.A.D.); (W.V.); (A.T.); (C.G.); (R.L.); (M.T.); (R.M.T.); (T.L.); (D.H.); (R.F.); (S.V.); (G.S.)
| | - Marialisa Trivigno
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (M.S.B.); (G.C.); (M.A.D.); (W.V.); (A.T.); (C.G.); (R.L.); (M.T.); (R.M.T.); (T.L.); (D.H.); (R.F.); (S.V.); (G.S.)
| | - Roberto Michele Tunzi
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (M.S.B.); (G.C.); (M.A.D.); (W.V.); (A.T.); (C.G.); (R.L.); (M.T.); (R.M.T.); (T.L.); (D.H.); (R.F.); (S.V.); (G.S.)
| | - Tommaso Loizzo
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (M.S.B.); (G.C.); (M.A.D.); (W.V.); (A.T.); (C.G.); (R.L.); (M.T.); (R.M.T.); (T.L.); (D.H.); (R.F.); (S.V.); (G.S.)
| | - Dritan Hila
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (M.S.B.); (G.C.); (M.A.D.); (W.V.); (A.T.); (C.G.); (R.L.); (M.T.); (R.M.T.); (T.L.); (D.H.); (R.F.); (S.V.); (G.S.)
| | - Rosalba Franchino
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (M.S.B.); (G.C.); (M.A.D.); (W.V.); (A.T.); (C.G.); (R.L.); (M.T.); (R.M.T.); (T.L.); (D.H.); (R.F.); (S.V.); (G.S.)
| | - Vincenzo Amodeo
- Department of Cardiology, Hospital of Polistena, 89024 Polistena, Italy;
| | - Simone Ventra
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (M.S.B.); (G.C.); (M.A.D.); (W.V.); (A.T.); (C.G.); (R.L.); (M.T.); (R.M.T.); (T.L.); (D.H.); (R.F.); (S.V.); (G.S.)
| | - Giuseppe Diaferia
- Department of Cardiology, “M. Di Miccoli” Hospital, 70051 Barletta, Italy;
| | - Giacomo Schinco
- Health Management, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy;
| | - Felice Eugenio Agrò
- Department of Anesthesiology, University Campus Bio Medico, 00128 Rome, Italy;
| | - Maddalena Zingaro
- Department of Cardiology, Hospital of Andria, 76123 Andria, Italy; (C.L.); (F.B.); (M.Z.); (I.R.)
| | - Isabella Rosa
- Department of Cardiology, Hospital of Andria, 76123 Andria, Italy; (C.L.); (F.B.); (M.Z.); (I.R.)
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University, 6229 Maastricht, The Netherlands;
| | - Armando Del Prete
- Department of Cardiology, Santa Maria Goretti Hospital, 04100 Latina, Italy;
| | - Giuseppe Santarpino
- Department of Clinical and Experimental Medicine, Magna Graecia University, 88100 Catanzaro, Italy;
- Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, 73100 Lecce, Italy
| | - Giuseppe Speziale
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, 70124 Bari, Italy; (M.S.B.); (G.C.); (M.A.D.); (W.V.); (A.T.); (C.G.); (R.L.); (M.T.); (R.M.T.); (T.L.); (D.H.); (R.F.); (S.V.); (G.S.)
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