Clinical research

DOI: 10.4244/EIJ-D-23-00201

Impact of alirocumab on plaque regression and haemodynamics of non-culprit arteries in patients with acute myocardial infarction: a prespecified substudy of the PACMAN-AMI trial

Sarah Bär1, MD; Raminta Kavaliauskaite1, MD; Tatsuhiko Otsuka1,2, MD; Yasushi Ueki1,3, MD, PhD; Jonas D. Häner1, MD; George C.M. Siontis1, MD, PhD; Stefan Stortecky1, MD; Hiroki Shibutani1,4, MD; Fabrice Temperli1, MD; Christoph Kaiser5, MD; Juan F. Iglesias6, MD; Robert Jan van Geuns7, MD, PhD; Joost Daemen8, MD, PhD; David Spirk9,10, MD; Thomas Engstrøm11, MD, PhD; Irene Lang12, MD; Stephan Windecker1, MD; Konstantinos C. Koskinas1, MD, MSc; Sylvain Losdat13, PhD; Lorenz Räber1, MD, PhD


Background: Treatment with proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors on top of statins leads to plaque regression and stabilisation. The effects of PCSK9 inhibitors on coronary physiology and angiographic diameter stenosis (DS%) are unknown.

Aims: This study aimed to investigate the effects of the PCSK9 inhibitor alirocumab on coronary haemodynamics as assessed by quantitative flow ratio (QFR) and DS% by three-dimensional quantitative coronary angiography (3D-QCA) in non-infarct-related arteries (non-IRA) among acute myocardial infarction (AMI) patients.

Methods: This was a prespecified substudy of the randomised controlled PACMAN-AMI trial, comparing alirocumab versus placebo on top of rosuvastatin. QFR and 3D-QCA were assessed at baseline and 1 year in any non-IRA ≥2.0 mm and 3D-QCA DS% >25%. The prespecified primary endpoint was the number of patients with a mean QFR increase at 1 year, and the secondary endpoint was the change in 3D-QCA DS%.

Results: Of 300 enrolled patients, 265 had serial follow-up, of which 193 underwent serial QFR/3D-QCA analysis in 282 non-IRA. At 1 year, QFR increased in 50/94 (53.2%) patients with alirocumab versus 40/99 (40.4%) with placebo (Δ12.8%;...

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Volume 19 Number 4
Jul 17, 2023
Volume 19 Number 4
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