CONGRESS ABSTRACT

This real-world analysis evaluates the clinical and economic impact of implementing a predefined 'Strike Early and Strong' (SEaS) lipid-lowering therapy protocol in patients at very high cardiovascular risk. On a total sample of 500 consecutive patients with acute myocardial infarction (AMI), three treatment periods characterized by different strategies were compared: 2019: LDL cholesterol target was <70 mg/dl, and a "stepwise" lipid-lowering approach was recommended. 2021: LDL cholesterol target was updated to <55 mg/dl, while the "stepwise" approach remained the recommended strategy. 2023: LDL cholesterol target was maintained at <55 mg/dl with SEaS strategy implemented. This approach optimized the use of high-dose potent statins at discharge and, when necessary, included the addition of ezetimibe and/or iPCSK9. The clinical data show a significant reduction in the rates of major adverse cardiovascular events (MACE) at 1 year, decreasing from 12.12% in 2019 and 11.11% in 2021 to 3.28% in 2023. The effectiveness of the SEaS approach demonstrated a progressive improvement in treatment outcomes, achieved through the integration of statin + ezetimibe in 56% of patients and the early introduction of iPCSK9 in 22% of patients. The economic analysis considered the costs of therapies, laboratory tests, and cardiovascular events, focusing on direct costs from the perspective of the NHS. The Incremental Cost-Effectiveness Ratio (ICER) amounted to € 5,667.16 / median effectiveness point during the 2019–2023 period, while for the 2021–2023 period, the ICER was € 6,398.02 / median effectiveness point. The early introduction of iPCSK9 in AMI with the SEaS strategy leads to an increase in treatment costs alongside a significant improvement in clinical effectiveness. This demonstrates the acceptability of the strategy, as it remains below the €50,000 threshold, confirmed by the sensitivity analysis. In the Budget Impact Analysis of 100 patients, costs ranged from €183,315 in 2019 to €123,807 in 2021, and €155,004 in 2023. The costs in 2023 were lower than in 2019, primarily due to a substantial reduction in the number of patients experiencing MACE within one year (decreasing from 24 cases in 2019 to 4 cases in 2023). The comprehensive economic analysis suggests that the early adoption of a SEaS lipid-lowering approach in AMI patients leads to significant clinical improvements, is cost-effective, and sustainable, representing an excellent investment for the NHS.