Effect of proprotein convertase subtilisin/kexin type 9 inhibitor on lipoprotein(a)level in patients with acute ST-segment elevation myocardial infarction

Huang Xiaofeng; Lu Yu'e; Chen Lidai; Lyu Cheng; Luo Hongchang; Yang Fan

doi:10.3760/j.issn.1673-4777.2026.03.003

Abstract：Objective To observe the effect of proprotein convertase subtilisin/kexin type 9(PCSK9)inhibitor on lipoprotein(a)level in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 60 STEMI patients admitted to Liuzhou Workers'Hospital,Guangxi Zhuang Autonomous Region from January to July 2024 were enrolled.The patients were divided into the control group and the observation group according to the random number table method,with 30 cases in each group.Both groups received standard treatment,and the observation group was subcutaneously injected with evolocumab 140 mg immediately after primary percutaneous coronary intervention(PPCI)on the basis of standard treatment.The levels of peripheral blood PCSK9 and lipoprotein(a)were measured before PPCI as well as on the 3rd,7th and 14th days after PPCI.The differences between the two groups were compared,and the correlation between PCSK9 and lipoprotein(a)was analyzed.Results On the 3rd,7th and 14th days after surgery,the serum PCSK9 concentrations in both groups were lower than those before surgery.Compared with the control group,the serum PCSK9 concentration in the observation group showed a faster and more significant downward trend,and the PCSK9 concentrations in the observation group were lower than those in the control group on the 3rd,7th and 14th days after surgery(all P＜0.05).On the 14th day after surgery,the lipoprotein(a)level in the observation group was significantly lower than that in the control group[169.5(108.3,194.7)mg/L vs 224.7(140.1,308.5)mg/L](Z=-4.482,P＜0.001).Spearman correlation analysis showed that serum PCSK9 concentration was significantly positively correlated with lipoprotein(a)concentration in STEMI patients(r=0.248,P＜0.001).Conclusion Administration of PCSK9 inhibitor within 24 hours after PPCI can significantly accelerate lipoprotein(a)metabolism,with a 33.8％reduction on the 14th day after surgery,which is significantly superior to standard treatment alone.The decrease of lipoprotein(a)presents a delayed acceleration mode and is closely related to the degree of PCSK9 inhibition,which provides a new path reference for precise residual risk management in patients with STEMI.