Heart attack patients gained faster control of LDL cholesterol starting PCSK9 inhibitor therapy immediately in the cath lab, the AMUNDSEN trial showed, while a clinical benefit could not be proven.
High-risk patients with acute myocardial infarction (MI) who had a first injection of evolocumab (Repatha) right before percutaneous coronary intervention (PCI) were significantly more likely to achieve cholesterol targets 1 year into the study, reported Gilles Montalescot, MD, PhD, of Pitié-Salpêtrière Hospital in Paris.
The proportion of patients reaching LDL cholesterol <55 mg/dL and at least 50% reduction from baseline to 12 months came out to 82% among those given upfront evolocumab versus 40% of peers randomized to standard care (adjusted OR 5.54, 95% CI 4.50-6.82).
Meanwhile, the evolocumab and control groups shared similar rates of all-cause death or unplanned cardiovascular hospitalization at 12 months (14.6% vs 15.4%, adjusted OR 0.94, 95% CI 0.73-1.19) in this study of over 2,100 participants, Montalescot reported at the European Society of Cardiology Congress in Munich, Germany. The study was simultaneously published in JAMA.
This would suggest no clinically meaningful acute pleiotropic effects of PCSK9 inhibitors, beyond LDL cholesterol-mediated effects, in adjunct to standard care, the AMUNDSEN trialists suggested.
