The significance and prospect of PCSK9 inhibitors for the transformation of treatment strategies of CHIP patients
-
摘要: 高危复杂冠心病患者(CHIP)因冠脉病变解剖复杂或病情危重,传统药物治疗效果有限,往往需要高风险的复杂冠脉介入治疗。近年来,前蛋白转换酶枯草溶菌素9(PCSK9)抑制剂在冠心病的心血管不良事件获益上表现优异,对于CHIP这类特殊患者,PCSK9抑制剂的应用是否可减少支架植入,甚至对部分CHIP患者实现“药物血运重建”?乃至改变CHIP患者治疗策略选择,降低其需要高危介入治疗的风险,以及PCSK9抑制剂在CHIP患者的最佳应用时机,将是未来研究的热点。
-
关键词:
- 前蛋白转换酶枯草溶菌素9抑制剂 /
- 高危复杂冠心病 /
- 低密度脂蛋白胆固醇 /
- 心血管不良事件
Abstract: Complex high-risk indicated patients(CHIPs) often need high-risk and complex coronary interventional therapy due to the limited efficacy of traditional drug therapy. In recent years, PCSK9 inhibitors have performed well in the benefits of cardiovascular adverse events in coronary heart disease. Inthe future research, Theywill be the novel focus in CHIP patients, such aswhether the application of PCSK9 inhibitors can reduce stent implantation, and even achieve "drug revascularization", the changes of treatment strategies whichreduces the risk of high-risk interventional therapy, as well as the optimal time of PCSK9 inhibitors. -
[1] Kirtane AJ, Doshi D, Leon MB, et al. Treatment of higher-risk patients with an indication for revascularization: evolution within the field of contemporary percutaneous coronary intervention[J]. Circulation, 2016, 134(5): 422-431. doi: 10.1161/CIRCULATIONAHA.116.022061
[2] Sabatine MS. PCSK9 inhibitors: clinical evidence and implementation[J]. Nat Rev Cardiol, 2019, 16(3): 155-165. doi: 10.1038/s41569-018-0107-8
[3] Kinnaird T, Gallagher S, Spratt JC, et al. Complex high-risk and indicated percutaneous coronary intervention for stable angina: Does operator volume influence patient outcome?[J]. Am Heart J, 2020, 222: 15-25. doi: 10.1016/j.ahj.2019.12.019
[4] Brener SJ, Cunn GJ, Desai PH, et al. A Novel risk score to predict one-year mortality in patients undergoing complex high-risk indicated percutaneous coronary intervention(CHIP-PCI)[J]. J Invasive Cardiol, 2021, 33(4): E253-E258.
[5] 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[J]. JAMA, 2022, 327(18): 1771-1781. doi: 10.1001/jama.2022.5218
[6] Nicholls SJ, Puri R, Anderson T, et al. Effect of evolocumab on progression of coronary disease in statin-treated patients: The GLAGOV Randomized Clinical Trial[J]. JAMA, 2016, 316(22): 2373-2384. doi: 10.1001/jama.2016.16951
[7] Barale C, Bonomo K, Frascaroli C, et al. Platelet function and activation markers in primary hypercholesterolemia treated with anti-PCSK9 monoclonal antibody: A 12-month follow-up[J]. Nutr Metab Cardiovasc Dis, 2020, 30(2): 282-291. doi: 10.1016/j.numecd.2019.09.012
[8] Cammisotto V, Baratta F, Castellani V, et al. Proprotein convertase subtilisin Kexin Type 9 inhibitors reduce platelet activation modulating ox-LDL pathways[J]. Int J Mol Sci, 2021, 22(13): 100.
[9] Sabatine MS, Giugliano RP, Keech AC, et al. Evolocumab and clinical outcomes in patients with cardiovascular disease[J]. N Engl J Med, 2017, 376(18): 1713-1722. doi: 10.1056/NEJMoa1615664
[10] Oyama K, Furtado R, Fagundes A Jr, et al. Effect of evolocumab on complex coronary disease requiring revascularization[J]. J Am Coll Cardiol, 2021, 77(3): 259-267. doi: 10.1016/j.jacc.2020.11.011
[11] Schwartz GG, Steg PG, Szarek M, et al. Alirocumab and cardiovascular outcomes after acute coronary syndrome[J]. N Engl J Med, 2018, 379(22): 2097-2107. doi: 10.1056/NEJMoa1801174
[12] Erlinge D, Maehara A, Ben-Yehuda O, et al. Identification of vulnerable plaques and patients by intracoronary near-infrared spectroscopy and ultrasound(PROSPECT Ⅱ): a prospective natural history study[J]. Lancet, 2021, 397(10278): 985-995. doi: 10.1016/S0140-6736(21)00249-X
[13] Cannon CP, Braunwald E, McCabe CH, et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes[J]. N Engl J Med, 2004, 350(15): 1495-1504. doi: 10.1056/NEJMoa040583
[14] Schwartz GG, Olsson AG, Ezekowitz MD, et al. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial[J]. JAMA, 2001, 285(13): 1711-1718. doi: 10.1001/jama.285.13.1711
[15] Koskinas KC, Windecker S, Pedrazzini G, et al. Evolocumab for early reduction of LDL cholesterol levels in patients with acute coronary syndromes(EVOPACS)[J]. J Am Coll Cardiol, 2019, 74(20): 2452-2462. doi: 10.1016/j.jacc.2019.08.010
[16] Leucker TM, Blaha MJ, Jones SR, et al. Effect of evolocumab on atherogenic lipoproteins during the peri-and early postinfarction period: A Placebo-Controlled, Randomized Trial[J]. Circulation, 2020, 142(4): 419-421. doi: 10.1161/CIRCULATIONAHA.120.046320
[17] Nicholls SJ, Kataoka Y, Nissen SE, et al. Effect of evolocumab on coronary plaque phenotype and burden in statin-treated patients following myocardial infarction[J]. JACC Cardiovasc Imaging, 2022, 111: 120.
[18] Ray KK, Wright RS, Kallend D, et al. Two phase 3 trials of inclisiran in patients with elevated LDL cholesterol[J]. N Engl J Med, 2020, 382: 1507-1519. doi: 10.1056/NEJMoa1912387
计量
- 文章访问数: 1254
- PDF下载数: 569
- 施引文献: 0