Atherosclerosis plaque causing AMI is often large in volume, high in lipids and have a thin fibrous cap. Statins often reduce atherosclerosis progress, but the impact of PCSK 9 inhibitors (alirocumab) after acute coronary syndrome is scarcely known.
The aim of this study was to determine the effect of alirocumab using intracoronary imaging (IVUS, OCT, near-infrared spectroscopy (NIRS) in AMI patients.
It included 300 patients mean age 58; 18% were women. There were STEMI (53%) and NSTEMI patients (47%) receiving culprit vessel PCI with no obstructive lesions in other arteries (20 toa 50% stenosis).
Patients were randomized within 24 hrs. of PCI to receiving alirocumab 150 mg every 2 weeks in addition to 20 mg rosuvastatin vs placebo + rosuvastatin. Primary end point was changes in plaque volume by IVUS. Secondary end point was changes to the lipidic core by NIRS, and changes to fibrous cap thickness by OCT.
There was plaque volume reduction in favor of the alirocumab (P<0.001). there were also significant differences in secondary end point for the intervention group.
Read also: ACC 2022 | PROMPT-HF.
At one year, LDL values saw 50% reduction in the placebo group vs. 84% in the alirocumab group. As regards safety, the only significant adverse event in the intervention group was an allergic reaction.
Conclusion
Among AMI patients, subcutaneous addition of alirocumab twice a week compared against placebo resulted in regression of atherosclerosis plaque 52 weeks after index event.
Dr. Andrés Rodríguez.
Member of the Editorial Board ofSOLACI.org .
Reference: Räber L, Ueki Y, Otsuka T, et al. Effect of alirocumab added to high-intensity statin therapy on coronary atherosclerosis in patients with acute myocardial infarction: the PACMAN-AMI randomized clinical trial. JAMA. 2022;Epub ahead of print.
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