Rush to PCSK9 Inhibitor Pretreatment Disappoints in Acute MI Trial
(MedPage Today) -- 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...
A recent study, AMUNDSEN, conducted on heart attack patients received mixed results when comparing the effects of starting PCSK9 inhibitor therapy immediately before a catheterization procedure versus receiving standard care. The trial, led by Gilles Montalescot, MD, PhD, of Pitié-Salpêtrière Hospital in Paris, involved over 2,100 patients with acute myocardial infarction (MI) and found that those who received evolocumab (Repatha) right before percutaneous coronary intervention (PCI) were more likely to achieve LDL cholesterol targets at one year.
However, this benefit was not statistically significant (82% vs. 40%, adjusted OR 5.54, 95% CI 4.50-6.82). The study also revealed no clinically meaningful acute pleiotropic effects of PCSK9 inhibitors beyond their LDL cholesterol-mediated effects, suggesting that such treatment may not provide additional benefits in adjunct to standard care.
Experts have pointed out that this study does not support the concept of starting treatment early in hospitalization for better outcomes, as most trials of similar nature have shown a lag phase before clinical benefit emerges.
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