Efficacy and safety of PCSK-9 inhibitors in patients with acute coronary syndrome: a systematic review and network meta-analysis
Abstract Background Acute coronary syndrome (ACS) remains a leading cause of global cardiovascular morbidity and mortality, with elevated low-density lipoprotein cholesterol (LDL-C) being a key modifiable risk factor. Despite statin therapy, many patients fail to achieve optimal LDL-C targets, highl...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-08-01
|
| Series: | BMC Cardiovascular Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12872-025-05070-3 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849226641563189248 |
|---|---|
| author | Guoying Kao Chuan Chen Ying Zhang Yi Xu Gang Xu |
| author_facet | Guoying Kao Chuan Chen Ying Zhang Yi Xu Gang Xu |
| author_sort | Guoying Kao |
| collection | DOAJ |
| description | Abstract Background Acute coronary syndrome (ACS) remains a leading cause of global cardiovascular morbidity and mortality, with elevated low-density lipoprotein cholesterol (LDL-C) being a key modifiable risk factor. Despite statin therapy, many patients fail to achieve optimal LDL-C targets, highlighting the need for adjunctive treatments such as PCSK9 inhibitors (e.g., Evolocumab and Alirocumab). However, comparative evidence on their efficacy and safety in ACS patients remains limited. Objective To systematically evaluate the efficacy and safety of PCSK9 inhibitors (Evolocumab and Alirocumab) in patients with ACS, focusing on LDL-C reduction and major adverse cardiovascular events (MACE). Methods A comprehensive search was conducted in PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and the WHO International Clinical Trials Registry. Eligible randomized controlled trials (RCTs) assessed PCSK9 inhibitors in ACS patients and reported outcomes on LDL-C and MACE. Both direct and network meta-analyses were performed to compare effect sizes across interventions. No direct head-to-head trials between Evolocumab and Alirocumab were identified. Results Nine RCTs involving 37,934 patients were included. Direct meta-analysis showed that PCSK9 inhibitors significantly reduced LDL-C (mean difference [MD]: − 52.7 mg/dL; 95% CI: − 61.2 to − 44.1) and lowered the risk of MACE (odds ratio [OR]: 0.79; 95% CI: 0.68–0.93). In subgroup analysis, Evolocumab produced greater LDL-C reductions, while Alirocumab showed a stronger trend toward MACE reduction, though not statistically significant (OR: 0.84; 95% CI: 0.68–1.03). Network meta-analysis confirmed these patterns but revealed no statistically significant differences between the two agents. Conclusion PCSK9 inhibitors significantly improve lipid profiles and reduce cardiovascular event risk in ACS patients. While Evolocumab and Alirocumab offer similar overall benefits, their differential effects on LDL-C and MACE warrant further investigation. These findings support the role of PCSK9 inhibitors in secondary prevention strategies for high-risk cardiovascular populations. |
| format | Article |
| id | doaj-art-5173fd8befbe4c5f979b4d4b45d50be8 |
| institution | Kabale University |
| issn | 1471-2261 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj-art-5173fd8befbe4c5f979b4d4b45d50be82025-08-24T11:06:59ZengBMCBMC Cardiovascular Disorders1471-22612025-08-0125111310.1186/s12872-025-05070-3Efficacy and safety of PCSK-9 inhibitors in patients with acute coronary syndrome: a systematic review and network meta-analysisGuoying Kao0Chuan Chen1Ying Zhang2Yi Xu3Gang Xu4Department of Cardiovascular Medicine, Chongqing Emergency Medical Center, Chongqing University Central HospitalDepartment of Cardiovascular Medicine, Chongqing Emergency Medical Center, Chongqing University Central HospitalDepartment of Cardiovascular Medicine, Chongqing Emergency Medical Center, Chongqing University Central HospitalDepartment of Cardiovascular Medicine, Chongqing Emergency Medical Center, Chongqing University Central HospitalDepartment of Cardiovascular Medicine, Chongqing Emergency Medical Center, Chongqing University Central HospitalAbstract Background Acute coronary syndrome (ACS) remains a leading cause of global cardiovascular morbidity and mortality, with elevated low-density lipoprotein cholesterol (LDL-C) being a key modifiable risk factor. Despite statin therapy, many patients fail to achieve optimal LDL-C targets, highlighting the need for adjunctive treatments such as PCSK9 inhibitors (e.g., Evolocumab and Alirocumab). However, comparative evidence on their efficacy and safety in ACS patients remains limited. Objective To systematically evaluate the efficacy and safety of PCSK9 inhibitors (Evolocumab and Alirocumab) in patients with ACS, focusing on LDL-C reduction and major adverse cardiovascular events (MACE). Methods A comprehensive search was conducted in PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and the WHO International Clinical Trials Registry. Eligible randomized controlled trials (RCTs) assessed PCSK9 inhibitors in ACS patients and reported outcomes on LDL-C and MACE. Both direct and network meta-analyses were performed to compare effect sizes across interventions. No direct head-to-head trials between Evolocumab and Alirocumab were identified. Results Nine RCTs involving 37,934 patients were included. Direct meta-analysis showed that PCSK9 inhibitors significantly reduced LDL-C (mean difference [MD]: − 52.7 mg/dL; 95% CI: − 61.2 to − 44.1) and lowered the risk of MACE (odds ratio [OR]: 0.79; 95% CI: 0.68–0.93). In subgroup analysis, Evolocumab produced greater LDL-C reductions, while Alirocumab showed a stronger trend toward MACE reduction, though not statistically significant (OR: 0.84; 95% CI: 0.68–1.03). Network meta-analysis confirmed these patterns but revealed no statistically significant differences between the two agents. Conclusion PCSK9 inhibitors significantly improve lipid profiles and reduce cardiovascular event risk in ACS patients. While Evolocumab and Alirocumab offer similar overall benefits, their differential effects on LDL-C and MACE warrant further investigation. These findings support the role of PCSK9 inhibitors in secondary prevention strategies for high-risk cardiovascular populations.https://doi.org/10.1186/s12872-025-05070-3Acute coronary syndromePCSK-9LDL-CMACENetwork meta-analysis |
| spellingShingle | Guoying Kao Chuan Chen Ying Zhang Yi Xu Gang Xu Efficacy and safety of PCSK-9 inhibitors in patients with acute coronary syndrome: a systematic review and network meta-analysis BMC Cardiovascular Disorders Acute coronary syndrome PCSK-9 LDL-C MACE Network meta-analysis |
| title | Efficacy and safety of PCSK-9 inhibitors in patients with acute coronary syndrome: a systematic review and network meta-analysis |
| title_full | Efficacy and safety of PCSK-9 inhibitors in patients with acute coronary syndrome: a systematic review and network meta-analysis |
| title_fullStr | Efficacy and safety of PCSK-9 inhibitors in patients with acute coronary syndrome: a systematic review and network meta-analysis |
| title_full_unstemmed | Efficacy and safety of PCSK-9 inhibitors in patients with acute coronary syndrome: a systematic review and network meta-analysis |
| title_short | Efficacy and safety of PCSK-9 inhibitors in patients with acute coronary syndrome: a systematic review and network meta-analysis |
| title_sort | efficacy and safety of pcsk 9 inhibitors in patients with acute coronary syndrome a systematic review and network meta analysis |
| topic | Acute coronary syndrome PCSK-9 LDL-C MACE Network meta-analysis |
| url | https://doi.org/10.1186/s12872-025-05070-3 |
| work_keys_str_mv | AT guoyingkao efficacyandsafetyofpcsk9inhibitorsinpatientswithacutecoronarysyndromeasystematicreviewandnetworkmetaanalysis AT chuanchen efficacyandsafetyofpcsk9inhibitorsinpatientswithacutecoronarysyndromeasystematicreviewandnetworkmetaanalysis AT yingzhang efficacyandsafetyofpcsk9inhibitorsinpatientswithacutecoronarysyndromeasystematicreviewandnetworkmetaanalysis AT yixu efficacyandsafetyofpcsk9inhibitorsinpatientswithacutecoronarysyndromeasystematicreviewandnetworkmetaanalysis AT gangxu efficacyandsafetyofpcsk9inhibitorsinpatientswithacutecoronarysyndromeasystematicreviewandnetworkmetaanalysis |