Eligibility for PCSK9 Inhibitors According to American College of Cardiology (ACC) and European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) Guidelines After Acute Coronary Syndromes.

Détails

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Etat: Public
Version: Final published version
Licence: CC BY-NC 4.0
ID Serval
serval:BIB_6ADD45556097
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Eligibility for PCSK9 Inhibitors According to American College of Cardiology (ACC) and European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) Guidelines After Acute Coronary Syndromes.
Périodique
Journal of the American Heart Association
Auteur⸱e⸱s
Gencer B., Koskinas K.C., Räber L., Karagiannis A., Nanchen D., Auer R., Carballo D., Carballo S., Klingenberg R., Heg D., Matter C.M., Lüscher T.F., Rodondi N., Mach F., Windecker S.
ISSN
2047-9980 (Electronic)
ISSN-L
2047-9980
Statut éditorial
Publié
Date de publication
09/11/2017
Peer-reviewed
Oui
Volume
6
Numéro
11
Pages
NA
Langue
anglais
Notes
Publication types: Journal Article ; Multicenter Study ; Observational Study
Publication Status: epublish
Résumé
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 (PCSK9) inhibitors in situations of very high risk. We aim to assess in the real world the suitability of PCSK9 inhibitors for acute coronary syndromes.
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 PCSK9 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 PCSK9 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 ( <i>P</i> <0.001).
Recommendations made by the American College of Cardiology guidelines would lead to 5-fold higher eligibility rates for PCSK9 inhibitors compared to the European Society of Cardiology/European Atherosclerosis Society consensus statement in acute coronary syndrome patients.
Mots-clé
Acute Coronary Syndrome/blood, Acute Coronary Syndrome/drug therapy, Anticholesteremic Agents/administration & dosage, Apoptosis, Cardiology, Cholesterol, LDL/blood, Dose-Response Relationship, Drug, Eligibility Determination/methods, Europe, Ezetimibe/administration & dosage, Female, Follow-Up Studies, Humans, Male, Middle Aged, Practice Guidelines as Topic, Proprotein Convertase 9/antagonists & inhibitors, Prospective Studies, Societies, Medical, Time Factors, Treatment Outcome, United States, PCSK9, lipids, secondary prevention
Pubmed
Web of science
Open Access
Oui
Création de la notice
22/11/2017 9:36
Dernière modification de la notice
20/08/2019 14:25
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