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Schiele F, Puymirat E, Ferrieres J, Onceanu S, Beard T, Marchand X, Landel J, Meneveau N, Simon T, Danchin N. 468Patients eligible for proprotein convertase subtilisin/kexin type9 inhibitors (pcsk9i) after acute myocardial infarction. The ESC position applied to patients included in the FAST-MI 2015 registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
PCSK9i on top of high intensity statins have shown clinical benefit in patients after Acute Myocardial Infarction (AMI) who are not at LDL-c target. The ESC Task Force has defined guidance for the prescription of PCSK9i. Among patients discharged after AMI, the rate of those eligible for PCSCK9i is poorly documented.
Methods
We used data from the nationwide French FAST-MI 2015 registry. PSCK9-eligible patients were defined as those discharged with high intensity statins with expected-LDL>140 mg/dL, or >100mg/dL if they had additional high risk features such as diabetes with renal dysfunction or hypertension, multivessel coronary disease, associated peripheral artery disease or recurrent MI. The expected LDL-c was estimated from admission LDL-c and changes in lipid-lowering treatment. The rate of eligible patients was estimated from actual treatment and optimized treatment (i.e. addition of ezetimibe).
Results
Among 5291 pts included, 4715 (89%) were discharged with statins, at high intensity in 3655 (71%). Expected LDL was 71mg/dL (IQ 56, 95). Among patients discharged with high intensity statins, 3146 (59%) had an expected LDL-c<100/mg (figure, in green). PCSK9-eligible patients were those with LDL-c>140mg/dL (n=178, 3.3%, in red) and, among those with LDL-c 100–140mg/dL (n=331, 6.2%, in yellow), patients who had additional risk features (n=227 (4%)). As a result, the population eligible for PSCK9i according to the ESC guidance would represent 7.6% (405 pts) of the population admitted with AMI. Expanding the indication to patients with statins, but not at high intensity would add 159 (3%). Conversely, optimizing discharge treatment with ezetimibe would reduce the rate of eligible patients to 3% (181 pts, in brown).
Conclusions
In real life, according to the ESC Task Force, 7.6% of the whole population admitted for AMI would be eligible for PCK9i. This rate could be reduced to 3% with the addition of ezetimibe.
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Affiliation(s)
- F Schiele
- University Hospital of Besancon, Besancon, France
| | - E Puymirat
- European Hospital Georges Pompidou, Paris, France
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | | | - T Beard
- Polyclinique de l'Ormeau, Tarbes, France
| | - X Marchand
- Hospital Poissy-St Germain en Laye, Poissy, France
| | - J Landel
- Hospital Saint Philibert, Lomme, France
| | - N Meneveau
- University Hospital of Besancon, Besancon, France
| | - T Simon
- Hospital Saint-Antoine, Paris, France
| | - N Danchin
- European Hospital Georges Pompidou, Paris, France
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