Article Impact Level: HIGH Data Quality: STRONG Summary of EuroIntervention. https://doi.org/10.4244/EIJ-D-22-00735 Dr. Shamir Mehta et al
Points
- The trial’s main goal was to compare an inhibitor of pro-protein convertase subtilisin/kexin type 9 (PCSK9) alirocumab with sham-control among patients having Myocardial Infraction due to ST-segment Elevation (STEMI) and undertaking the primary percutaneous coronary intervention.
- The trial results indicated that alirocumab reduces the low-density lipoprotein cholesterol (LDL-C) level significantly compared to sham control when administered acutely during percutaneous coronary intervention.
- The acute use of alirocumab during STEMI seems to be practicable and safe.
- This trial was a small sample size; however, further studies are needed to check its efficacy at a broader level.
Summary
An EPIC-STEMI trial study was conducted to compare an inhibitor of pro-protein convertase subtilisin/kexin type 9 (PCSK9) alirocumab with sham-control among patients having Myocardial Infraction due to ST-segment Elevation (STEMI) and undertaking the primary percutaneous coronary intervention. For this trial, a parallel, randomized, and double-blind research was designed, and 68 patients with a mean age of 61years were selected and randomized into two groups of 38 patients with alirocumab and 30 patients in the sham control group. Alirocumab 150mg was given through subcutaneous injection, and study medicines were given at baseline, then after 2 weeks, and then after 4 weeks. High-dose statin therapy was given to all patients.
Female patients having pregnancy or breastfeeding their children were excluded from the study. Other patients who planned or having treatment with a PCSK9 inhibitor, have a contraindication/an allergy to a PCSK9 inhibitor, belong to Killip class equal or greater than 2, have creatinine clearance lower than 30 ml/min, are supposed to have stress-induced cardiomyopathy, or have acute pericarditis were also not included in the study.
The principal finding of the trial was a reduction in the level of low-density lipoprotein cholesterol within 6 weeks from baseline when alirocumab was used as compared to sham control. However, the infarct size among both study groups was similar. The acute use of alirocumab through STEMI seems to be practicable and safe. This trial was at a small sample size; however, further studies are needed to check its efficacy at a broader level.
References Mehta, S. R., Pare, G., Lonn, E. M., Jolly, S. S., Natarajan, M. K., Pinilla-Echeverri, N., Schwalm, J.-D., Sheth, T., Sibbald, M., Tsang, M., Valettas, N., Velianou, J. L., Lee, S. F., Ferdous, T., Nauman, S., Nguyen, H., McCready, T., & McQueen, M. J. (n.d.). Effects of routine early treatment with pcsk-9 inhibitor in patients undergoing primary percutaneous coronary intervention for st-segment elevation myocardial infarction: A randomized, double-blind, sham-controlled trial. EuroIntervention. https://doi.org/10.4244/EIJ-D-22-00735
