英克司兰与PCSK9单抗治疗急性冠脉综合征患者的降脂效果及血脂变异性:一项真实世界回顾性分析OA

Objective This study aims to assess the lipid-lowering efficacy of Inclisiran and proprotein convertase subtilisin/kexin type 9(PCSK9)monoclonal antibodies(PCSK9mAbs)in patients with Acute Coronary Syndrome(ACS)by utilizing real-world clinical data.Methods This study adopted a single-center retrospective cohort design,enrolling patients with ACS who were treated with Inclisiran or PCSK9 monoclonal antibodies(mAbs,including evolocumab and alirocumab)at the Cardiology Department of Tianjin Chest Hospital from Janu-ary 2022 to March 2024.All enrolled patients were those who failed to reach the low-density lipoprotein cholesterol(LDL-C)targets after at least 30 days of stable moderate-intensity statin therapy.By using propensity score match-ing at a 1∶2 ratio,the patients were divided into an Inclisiran group(n=31)and a PCSK9 monoclonal antibody group(n=55).Lipid profiles were collected and analyzed at the start of treatment and during three follow-up visits(1～3 months,3～9 months,and 9～12 months after discharge).The differences between the two groups were compared in terms of the percentage reduction of LDL-C from the baseline,the LDL-C target achievement rates,the trend of LDL-C changes,and the cumulative LDL-C exposure during the follow-up period.The differences in LDL-C variability between the two groups were evaluated by the standard deviation(SD)and the average successive variability(ASV).Results The LDL-C reduction in the Inclisiran group was significantly superior to that in the PCSK9 mAbs group at all three follow-up visits(P<0.05).In terms of the attainment rate,the Inclisiran group demonstrated a higher LDL-C target attainment rate than the PCSK9 monoclonal antibody group at each visit(P<0.05),and up to 80.65%of patients achieved sustained attainment(with a target value of 1.8 mmol/L).After adjusting for baseline LDL-C levels,the Inclisiran group showed a more substantial reduction in LDL-C than the PCSK9 monoclonal antibody group(β=-0.300,95%CI:-0.535 to-0.064,P=0.013).The trends of LDL-C changes over time were similar between the two groups.Moreover,the Inclisiran group had lower lipid variability(between-group P for SD=0.034;between-group P for ASV=0.029)and lower cumulative LDL-C exposure(P<0.01)compared to the PCSK9 monoclonal antibody group.Conclusion In statin-treated ACS patients,inclisiran demonstrated superiority over PCSK9 monoclonal antibodies(mAbs)in reducing LDL-C levels,enhancing target achievement rates,decreasing cumulative LDL-C exposure,and maintaining LDL-C stability.