Prognostic value of PCSK9 levels in patients with acute coronary syndromes.

Gencer, Baris; Montecucco, Fabrizio; Nanchen, David; Carbone, Federico; Klingenberg, Roland; Vuilleumier, Nicolas; Aghlmandi, Soheila; Heg, Dik; Räber, Lorenz; Auer, Reto; Jüni, Peter; Windecker, Stephan; Lüscher, Thomas F; Matter, Christian M; Rodondi, Nicolas; Mach, François (2016). Prognostic value of PCSK9 levels in patients with acute coronary syndromes. European Heart Journal, 37(6), pp. 546-53. Oxford University Press 10.1093/eurheartj/ehv637

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AIMS Proprotein convertase subtilisin kexin 9 (PCSK9) is an emerging target for the treatment of hypercholesterolaemia, but the clinical utility of PCSK9 levels to guide treatment is unknown. We aimed to prospectively assess the prognostic value of plasma PCSK9 levels in patients with acute coronary syndromes (ACS). METHODS AND RESULTS Plasma PCSK9 levels were measured in 2030 ACS patients undergoing coronary angiography in a Swiss prospective cohort. At 1 year, the association between PCSK9 tertiles and all-cause death was assessed adjusting for the Global Registry of Acute Coronary Events (GRACE) variables, as well as the achievement of LDL cholesterol targets of <1.8 mmol/L. Patients with higher PCSK9 levels at angiography were more likely to have clinical familial hypercholesterolaemia (rate ratio, RR 1.21, 95% confidence interval, CI 1.09-1.53), be treated with lipid-lowering therapy (RR 1.46, 95% CI 1.30-1.63), present with longer time interval of chest pain (RR 1.29, 95% CI 1.09-1.53) and higher C-reactive protein levels (RR 1.22, 95% CI 1.16-1.30). PCSK9 increased 12-24 h after ACS (374 ± 149 vs. 323 ± 134 ng/mL, P < 0.001). At 1 year follow-up, HRs for upper vs. lower PCSK9-level tertiles were 1.13 (95% CI 0.69-1.85) for all-cause death and remained similar after adjustment for the GRACE score. Patients with higher PCSK9 levels were less likely to reach the recommended LDL cholesterol targets (RR 0.81, 95% CI 0.66-0.99). CONCLUSION In ACS patients, high initial PCSK9 plasma levels were associated with inflammation in the acute phase and hypercholesterolaemia, but did not predict mortality at 1 year.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Aghlmandi, Soheila; Heg, Dierik Hans; Räber, Lorenz; Jüni, Peter; Windecker, Stephan and Rodondi, Nicolas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0195-668X

Publisher:

Oxford University Press

Language:

English

Submitter:

Judith Liniger

Date Deposited:

12 Feb 2016 09:50

Last Modified:

03 Mar 2016 15:57

Publisher DOI:

10.1093/eurheartj/ehv637

PubMed ID:

26655339

Uncontrolled Keywords:

Acute coronary syndromes; Cohort studies; Familial hypercholesterolaemia; Lipids; PCSK9

BORIS DOI:

10.7892/boris.75893

URI:

https://boris.unibe.ch/id/eprint/75893

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