It's best to have patients on aggressive lipid-lowering therapy before discharge after an acute ST-segment elevation myocardial infarction (STEMI), so why not start it right away — even in the cath lab — using some of the most potentLDL-lowering agents available?
That was a main idea behind the randomized, sham-controlled EPIC-STEMI trial, in which STEMI patients were started on a PCSK9 inhibitor immediately before direct percutaneous coronary intervention (PCI) and on top ofhigh-intensity statins.
Those in the trial getting the active agent showed a 22% drop in LDL-cholesterol levels by 6 weeks compared with the control group given a sham injection along with high-intensity statins. They were also more likely to meet LDL goals specified in some guidelines, including reduction by at least 50%. And those outcomes were achieved regardless of baseline LDL levels or prior statin use.
Adoption of the trial's early, aggressive LDL-reduction strategy in practice "has the potential to substantially reduce morbidity and mortality" in such cases "by further reducing LDL beyond statins in a much greater number of high-risk patients than are currently being treated with these agents," suggested principal investigator Shamir R. Mehta, MD, MSc, when presenting the findings September 19 at Transcatheter Cardiovascular Therapeutics (TCT) 2022
