The benefits of PCSK9 inhibitors in patients with acute coronary syndrome:a systematic review and meta-analysis

Background:Proprotein convertase subtilisin/kexin 9(PSCK9)inhibitors have been beneficial for many patients with hyperlipidemia.The objective of this study was to investigate the benefit of PSCK9 inhibitors in patients with acute coronary syndrome(ACS).Methods:We systematically searched PubMed,EMBASE,and Cochrane Clinical Trials(published before January 2023;no language restriction)to compare the treatment of patients with ACS using PCSK9 inhibitors and placebo.The primary end points were major adverse cardiovascular events,nonfatal myocardial infarction,cardiogenic death,stroke,hospitalization for recurrent ACS,and coronary revascularization.Fixed-or random-effects models were used to assess the aggregated data.Results:Of the 1686 identified studies,5 were eligible and included in our analysis(of a total of 38,005 participants,18,609 cases were placed in the PCSK9 inhibitor treatment group and 19,396 cases in the placebo group).Compared with the placebo group,PCSK9 inhibitors significantly reduced the major adverse cardiovascular events(odds ratio[OR]:0.83;95%confidence interval[CI]:0.77–0.88;P<0.00001)for patients following ACS.The incidence of nonfatal myocardial infarction(relative risk:0.80;95%CI:0.74–0.87;P<0.00001),cardiovascular death(OR:0.96;95%CI:0.83–1.10;P=0.56),stroke(OR:0.74;95%CI:0.63–0.88;P=0.0007),hospitalization for recurrent ACS(OR:0.57;95%CI:0.40–0.83;P=0.003),or coronary revascularization(OR:0.82;95%CI:0.76–0.88;P<0.00001)all demonstrated a significant decrease in the comparison between the 2 groups.Conclusion:This meta-analysis demonstrated that treatment with PCSK9 inhibitors in patients with ACS reduced the probability of multiple cardiovascular events and improved patient prognosis.

Drug-coated balloons are not inferior to drug-coated stents in the treatment of acute myocardial infarction and shorten the duration of dual antiplatelet treatment

Background:Drug-coated balloons(DCBs)are an up-and-coming tactic in treating in-stent restenosis and coronary artery small vessel disease,but their efficacy in treating acute myocardial infarction needs to be further explored.Methods:A meta-analysis of 7 studies was conducted to make a comparison with the results of DCB and drug-eluting stent implantation after a median follow-up of 15 months.Results:A total of 922 patients were included in this analysis in total,including 375 patients in the DCB group and 547 patients in the stent group.A total of 962 vascular diseases were manifested in the 2 groups.After 6 to 24 months of follow-up,there was no statistically significant difference with respect to major adverse cardiovascular events(odds ratio[OR]:0.82;95%confidence interval[CI]:0.52–1.29;Z=0.85;P=0.39),cardiac death(OR:0.92;95%CI:0.39–2.12;Z=0.21;P=0.84),target lesion revascularization(OR:1.09;95%CI:0.53–2.25;Z=0.24;P=0.81),late lumen loss(MD:−0.05;95%CI:−0.15 to 0.06;Z=0.85;P=0.40),or dual antiplatelet therapy(DAPT)(OR:1.04;95%CI:0.53–2.05;Z=0.11;P=0.91)between the 2 groups.In the DCB group,persistent residual stenosis or C-F dissection occurrence necessitated that a total of 30 patients receive extra bailout implantations.The rate of bailout stenting was 11.8%(95%CI:7.1–16).Moreover,the DCB group had a shorter DAPT duration compared with the stent group.Conclusion:Drug-coated balloons with shorter DAPT durations may be as effective and safe as stent therapy in treating acute myocardial infarction.