PCSK-9 inhibitors improve cardiovascular events after PCI in patients with chronic kidney disease

Objective: To investigate the correlation between Lp(a) levels and the degree of coronary artery stenosis in patients with coronary artery disease (CAD) complicated with chronic kidney disease (CKD); evaluate the predictive value of Lp(a) in patients with CAD complicated with CKD; and evaluate the clinical value of PCSK-9 inhibitors in patients with CAD complicated with CKD. Method: A total of 494 patients admitted to our hospital for coronary angiography from October 2017 to December 2019 were included in this study. The patients were divided into a CKD group (n = 247) and a non-CKD group (n = 247). The CKD patients were divided into 3 groups according to the glomerular filtration rate (eGFR). The Gensini score was used to evaluate the coronary plaque load. Changes in the blood lipid index and its correlation with the coronary Gensini score were analyzed. CAD patients with CKD who received PCI were further divided into a PCSK-9 inhibitor treatment group and a conventional treatment group to explore the lipid-lowering effect of a PCSK-9 inhibitor on major adverse cardiac events (MACEs)(cardiac death, nonfatal myocardial infarction, heart failure and angina readmissions). Result: The levels of TG and Lp(a) in the CKD group were greater than those in the non-CAD combined CKD group (P < 0.05). The HDL-C level in the CAD combined with CKD group was lower than that in the non-CAD combined with CKD group (P < 0.05). However, there were no significant differences in TC or HDL-C levels between the two groups (P > 0.05). Lp(a) was significantly positively correlated with the coronary Gensini score (r = 0.135, P < 0.05), and this correlation was observed only in the moderate renal insufficiency group (r = 0.222, P < 0.05). PCSK-9 inhibitors significantly reduced LDL-D (-30.28% vs. -4.44%, P = 0.000) and Lp(a) levels (-25.22% vs. -10%, P = 0.006) in patients with CKD. In addition, PCSK-9 inhibitors reduced the occurrence of MACEs in patients (HR: 0.27, 95% CI 0.07–0.99; P = 0.013). Conclusion: In CAD patients with CKD, the degree of coronary stenosis becomes increasingly severe with increasing Lp(a) levels, and the Lp(a) level can be used as a predictor of the degree of coronary stenosis in CAD patients with CKD. PCSK-9 inhibitors reduce the incidence of cardiovascular events in patients with CKD.