Eligibility for PCSK9 inhibitors according to American College of Cardiology (ACC) and European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines after acute coronary syndromes

Background--the american college of cardiology (acc) and european society of cardiology/european atherosclerosis society (esc/eas) have recently published recommendations for the use of proprotein convertase subtilisin/kexin-9 (pcsk9) inhibitors in situations of very high risk. we aim to assess in the real world the suitability of pcsk9 inhibitors for acute coronary syndromes. methods and results--we analyzed a prospective swiss cohort of 2023 patients hospitalized for acute coronary syndromes between 2009 and 2014 with available data for low-density lipoprotein cholesterol and lipid-lowering therapy at 1 year. clinical familial hypercholesterolemia was defined using the dutch lipid clinic network algorithm as unlikely,possible,probable,or definite. we simulated a fixed relative reduction of 24% in low-density lipoprotein cholesterol levels at 1 year in all patients not treated with ezetimibe,irrespective of the low-density lipoprotein cholesterol levels and statin regimen. at 1 year,94.3% of patients were treated with statin,5.8% with ezetimibe,and 35.8% of patients had on-target low-density lipoprotein cholesterol levels (<1.8 mmol/l); 25.6% met criteria for possible or probable/definite familial hypercholesterolemia. after a simulation of the lipid-lowering effect of ezetimibe,the proportion of patients who would be eligible for pcsk9 inhibitors at 1 year was 13.4% using american college of cardiology criteria and 2.7% using european society of cardiology/european atherosclerosis society criteria. patients with possible or probable/definite familial hypercholesterolemia were more eligible for pcsk9 inhibitors compared with their non-familial hypercholesterolemia counterparts: 27.6% versus 8.8% according to american college of cardiology criteria and 6.6% versus 1.8% according to european society of cardiology/european atherosclerosis society criteria (p < 0.001). conclusions--recommendations made by the american college of cardiology guidelines would lead to 5-fold higher eligibility rates for pcsk9 inhibitors compared to the european society of cardiology/european atherosclerosis society consensus statement in acute coronary syndrome patients. © 2017 the authors.