CONGRESS ABSTRACT

Background and Aims We evaluated the feasibility of an early triple lipid lowering therapy (LLT) with PCSK9 inhibitors in patients with acute coronary syndromes (ACS).    Methods In this multicenter experience, we consecutively enrolled patients with ACS from July 2023 to July 2024. The prescribed LLT was evaluated at discharge. Triple therapy with a high-intensity statin plus ezetimibe and PCSK9i was recommended in the following cases: patients already on statin or combination statin/ezetimibe therapy with LDL-C values > 70 mg/dl; patients not on LLT at the time of admission with LDL-C values > 70 mg/dl and at least one of diabetes mellitus (DM), multivessel coronary artery disease (MV) or peripheral arterial disease (PAD); patients not on LLT at the time of admission and with LDL-C values > 140 mg/dl even in the absence of DM, MV or PAD. A six-month follow-up was planned to determine LDL-C target attainment, compliance, side effects, and cardiovascular events.   Results We consecutively enrolled 217 patients discharged with high-intensity statin plus ezetimibe and in-hospital addition of PCSK9i (triple therapy). Of the 217 patients discharged in triple LLT, the median age was 61 years, 23% were female, 41% were current smokers, DM was present in 18%, and 49% had history of hypertension. The diagnosis at admission was ST-Elevation Myocardial Infarction in 53%, Non-ST-Elevation Myocardial Infarction in 32%, and unstable angina in 15% of cases; 12% of patients had history of myocardial infarction and 7% had history of peripheral artery disease (PAD); 20% were already on at least one statin therapy and the median LDL-C value at admission was 131 mg/dl. We have follow up at six months in 168 patients. In these patients the median LDL-C value was 42 mg/dl with a reduction of 68%. We achieved a 92% of patients at target (LDL < 55 mg/dl). 7 patients ) had unplanned percutaneous coronary angioplasty, 2 patients died   Conclusions In conclusion, the use of an early and strong lipid lowering approach in very high risk patients with in-hospital or at discharge PCSK9i administration is feasible, safe and it allows for the rapid achievement of target LDL-C levels and enables over 90% of patients to reach their target without the need for short-term follow-up (4-6 weeks) to adjust lipid-lowering therapy