Aim: 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 ACS patients from July to November
2023. 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
statin/ezetimibe therapy with LDL-C values > 70 mg/dl; patients not on LLT at 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 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 e!ects, and cardiovascular
events.
Results: We consecutively enrolled 264 patients, 95% of whom were discharged with high-intensity statin
plus ezetimibe and 29% discharged with in-hospital addition of PCSK9i (triple therapy). Of the 77
patients discharged in triple LLT, the median age was 71.4 years, 71% were male, 42% were
current smokers, DM was present in 19%, and 48% had history of hypertension. The diagnosis at
admission was ST-Elevation Myocardial Infarction in 66.2%, Non-ST-Elevation Myocardial
Infarction in 29.5%, and unstable angina in 4.3% of cases; 63% of patients had history of coronary
artery disease and 6.8% had history of peripheral artery disease (PAD); 19.6% were already on at
least one statin therapy and the median LDL-C value at admission was 128 mg/dl.
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 and safe. The complete results
of six-months follow-up and LDL-C values will be available for the congress.