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Association of Lipoprotein(a) With Changes in Coronary Atherosclerosis in Patients Treated With Alirocumab.
Circ Cardiovasc Imaging
November 2024
Department of Cardiology, Bern University Hospital, Inselspital (K.C.K., J.H., Y.U., T.O., H.S., R.K., F.P., M.A., J. Lanz, S.W., L.R.), University of Bern, Switzerland.
Background: Elevated Lp(a) (lipoprotein[a]) is a risk marker for atherosclerotic disease, but the underlying mechanisms remain elusive. We examined the association of Lp(a) with changes in coronary atherosclerosis following intensive lipid-lowering therapy.
Methods: In the PACMAN-AMI trial (Effects of the PCSK9 Antibody Alirocumab on Coronary Atherosclerosis in Patients With Acute Myocardial Infarction), 300 patients with acute myocardial infarction were randomized to receive biweekly alirocumab 150 mg or placebo in addition to high-intensity statins.
Effects of alirocumab on endothelial function and coronary atherosclerosis in myocardial infarction: A PACMAN-AMI randomized clinical trial substudy.
Atherosclerosis
May 2024
Department of Cardiology, Bern University Hospital Inselspital, Freiburgstrasse 18, 3010, Bern, Switzerland. Electronic address:
Background And Aims: The effects of protein convertase subtilisin/kexin type 9 (PCSK9) inhibitors on endothelial function as assessed by flow-mediated dilation (FMD) in patients with acute myocardial infarction (AMI) are unknown. Therefore, we aimed to investigate the effects of the PCSK9 inhibitor alirocumab added to high-intensity statin on FMD, and its association with coronary atherosclerosis in non-infarct related arteries using intracoronary intravascular ultrasound (IVUS), near-infrared spectroscopy (NIRS), and optical coherence tomography (OCT).
Methods: This was a pre-specified substudy among patients recruited at Bern University Hospital, Switzerland, for the randomized-controlled, double-blind, PACMAN-AMI trial, which compared the effects of biweekly alirocumab 150 mg vs.
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.
EuroIntervention
July 2023
Department of Cardiology, Bern University Hospital Inselspital, Bern, Switzerland.
Article Synopsis
- The study investigated the effects of the PCSK9 inhibitor alirocumab on coronary blood flow and artery narrowing in patients with acute myocardial infarction (AMI) receiving statin treatment.
- After one year, patients treated with alirocumab showed a significant reduction in angiographic diameter stenosis (DS%), meaning less artery narrowing compared to those on placebo.
- However, improvements in coronary blood flow, as measured by quantitative flow ratio (QFR), were not statistically significant, suggesting that while alirocumab helps with artery structure, it may not enhance overall coronary blood flow dynamics.
Effect of Alirocumab Added to High-Intensity Statin Therapy on Coronary Atherosclerosis in Patients With Acute Myocardial Infarction: The PACMAN-AMI Randomized Clinical Trial.
JAMA
May 2022
Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
Article Synopsis
- Coronary plaques that may lead to serious heart issues often have large lipid content and thin protective layers; while statins can help manage this condition, the impact of the drug alirocumab alongside statins is not fully understood.
- The PACMAN-AMI trial involved 300 patients who received either alirocumab or a placebo after heart procedures, lasting for one year alongside strong statin treatment.
- The study aimed to measure changes in plaque characteristics using advanced imaging techniques, focusing on the volume of atheroma, lipid content, and fibrous cap thickness after treatment.
Coronary Circulatory Indexes in Non-Infarct-Related Vascular Territories in a Porcine Acute Myocardial Infarction Model.
JACC Cardiovasc Interv
May 2020
Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain.
Objectives: The aim of this study was to evaluate temporal changes in coronary hemodynamic and physiological indexes in the non-infarct-related artery (IRA), which might be affected by adjacent infarcted myocardium, using an experimental animal model of acute myocardial infarction.
Background: There has been debate on the reliability of fractional flow reserve and resting pressure-derived indexes, including instantaneous wave-free ratio, in the non-IRA in patients with acute ST-segment elevation myocardial infarction.
Methods: In Yorkshire swine, acute myocardial infarction was simulated with selective balloon occlusion at the left circumflex coronary artery as the IRA for 30 min.
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