Surgeries & Interventions

Aggressive LDL Reduction Strategy

An aggressive new strategy may help lower LDL levels in patients with STEMI (ST-Segment Elevation Myocardial Infarction) – the most severe type of heart attack. 

Early high-intensity statin initiation is standard after STEMI, but many patients still don’t reach their target LDL levels. Clinicians will sometimes leverage PCSK-9 inhibitors to further reduce levels when other lipid-lowering therapy is insufficient. But new research suggests starting the powerful LDL-lowering agent earlier – like, in the cath lab – may be the most effective strategy. 

A trial presented at TCT showed that the PCSK-9 inhibitor alirocumab significantly reduced LDL-C levels compared with sham-control when given acutely during the blockage-clearing PCI procedure. 

STEMI patients undergoing PCI were randomized to alirocumab 150mg injection (n=38) versus sham-control (n= 30). Patients received medication at baseline, two weeks, and four weeks. All patients received high-dose statin therapy. 

  • The alirocumab group saw a 22.3% greater reduction in LDL-C levels at six weeks compared to the control group.
  • The proportion of people meeting the LDL cholesterol target of 54 mg/dL was 92.1% with alirocumab and 56.7% with control.

The LDL cholesterol reduction will hopefully translate to reduced inflammation in these patients, and as a result, better outcomes.

The Takeaway

Aggressive in-hospital PCSK-9 therapy (plus statins) for heart attack patients undergoing PCI would likely mean fewer deaths and cardiovascular events. While the trial was not designed to assess clinical outcomes (see: small sample size, short follow-up), it did show acute PCSK-9 injections were feasible and effectively lowered LDL-C levels. 

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