Role of PCSK9 in the course of ejection fraction change after ST‐segment elevation myocardial infarction: a pilot study
Aims Proprotein convertase subtilisin/kexin type 9 (PCSK9) has emerged as a therapeutic target for reducing plasma low‐density lipoprotein cholesterol. Beyond lipid control, recent findings suggest a deleterious effect of this protein in the pathogenesis of postmyocardial infarction left ventricle r...
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| Published in | ESC Heart Failure Vol. 7; no. 1; pp. 117 - 122 |
|---|---|
| Main Authors | , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
John Wiley & Sons, Inc
01.02.2020
John Wiley and Sons Inc Wiley |
| Subjects | |
| Online Access | Get full text |
| ISSN | 2055-5822 2055-5822 |
| DOI | 10.1002/ehf2.12533 |
Cover
| Abstract | Aims
Proprotein convertase subtilisin/kexin type 9 (PCSK9) has emerged as a therapeutic target for reducing plasma low‐density lipoprotein cholesterol. Beyond lipid control, recent findings suggest a deleterious effect of this protein in the pathogenesis of postmyocardial infarction left ventricle remodelling and heart failure‐related complications. The aim of this study was to assess the relationship between circulating PCSK9 and 6 month cardiac magnetic resonance imaging‐derived left ventricular ejection fraction (LVEF) after a first ST‐segment elevation myocardial infarction (STEMI).
Methods and results
We prospectively evaluated 40 patients with a first STEMI, LVEF < 50% and treated with primary percutaneous coronary intervention in which PCSK9 was measured 24 h postreperfusion. All patients underwent cardiac magnetic resonance imaging 1 week and 6 months after STEMI. Baseline characteristics were compared across median values of PCSK9. The association between PCSK9 levels and LVEF at 6 months was evaluated by analysis of covariance. The mean age of the sample was 60 ± 12 years and 33 (82.5%) were male patients. The infarct location was anterior in 27 patients (67.5%), and 9 patients (22.5%) were Killip class ≥ II. The mean 1 week and 6 month LVEF were 41 ± 7% and 48 ± 10%, respectively. The mean PCSK9 was 1.93 ± 0.38 U/mL. Testing the association between serum PCSK9 and 6 month LVEF with analysis of covariance revealed an inverse relationship (r = −0.35, P = 0.028). After multivariate adjustment, circulating PCSK9 remained significant and inversely associated with 6 month LVEF (P = 0.002).
Conclusions
In patients with a first STEMI with reduced ejection fraction at index admission and treated with primary percutaneous coronary intervention, circulating PCSK9 was associated with lower LVEF at 6 months. |
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| AbstractList | Proprotein convertase subtilisin/kexin type 9 (PCSK9) has emerged as a therapeutic target for reducing plasma low-density lipoprotein cholesterol. Beyond lipid control, recent findings suggest a deleterious effect of this protein in the pathogenesis of postmyocardial infarction left ventricle remodelling and heart failure-related complications. The aim of this study was to assess the relationship between circulating PCSK9 and 6 month cardiac magnetic resonance imaging-derived left ventricular ejection fraction (LVEF) after a first ST-segment elevation myocardial infarction (STEMI).AIMSProprotein convertase subtilisin/kexin type 9 (PCSK9) has emerged as a therapeutic target for reducing plasma low-density lipoprotein cholesterol. Beyond lipid control, recent findings suggest a deleterious effect of this protein in the pathogenesis of postmyocardial infarction left ventricle remodelling and heart failure-related complications. The aim of this study was to assess the relationship between circulating PCSK9 and 6 month cardiac magnetic resonance imaging-derived left ventricular ejection fraction (LVEF) after a first ST-segment elevation myocardial infarction (STEMI).We prospectively evaluated 40 patients with a first STEMI, LVEF < 50% and treated with primary percutaneous coronary intervention in which PCSK9 was measured 24 h postreperfusion. All patients underwent cardiac magnetic resonance imaging 1 week and 6 months after STEMI. Baseline characteristics were compared across median values of PCSK9. The association between PCSK9 levels and LVEF at 6 months was evaluated by analysis of covariance. The mean age of the sample was 60 ± 12 years and 33 (82.5%) were male patients. The infarct location was anterior in 27 patients (67.5%), and 9 patients (22.5%) were Killip class ≥ II. The mean 1 week and 6 month LVEF were 41 ± 7% and 48 ± 10%, respectively. The mean PCSK9 was 1.93 ± 0.38 U/mL. Testing the association between serum PCSK9 and 6 month LVEF with analysis of covariance revealed an inverse relationship (r = -0.35, P = 0.028). After multivariate adjustment, circulating PCSK9 remained significant and inversely associated with 6 month LVEF (P = 0.002).METHODS AND RESULTSWe prospectively evaluated 40 patients with a first STEMI, LVEF < 50% and treated with primary percutaneous coronary intervention in which PCSK9 was measured 24 h postreperfusion. All patients underwent cardiac magnetic resonance imaging 1 week and 6 months after STEMI. Baseline characteristics were compared across median values of PCSK9. The association between PCSK9 levels and LVEF at 6 months was evaluated by analysis of covariance. The mean age of the sample was 60 ± 12 years and 33 (82.5%) were male patients. The infarct location was anterior in 27 patients (67.5%), and 9 patients (22.5%) were Killip class ≥ II. The mean 1 week and 6 month LVEF were 41 ± 7% and 48 ± 10%, respectively. The mean PCSK9 was 1.93 ± 0.38 U/mL. Testing the association between serum PCSK9 and 6 month LVEF with analysis of covariance revealed an inverse relationship (r = -0.35, P = 0.028). After multivariate adjustment, circulating PCSK9 remained significant and inversely associated with 6 month LVEF (P = 0.002).In patients with a first STEMI with reduced ejection fraction at index admission and treated with primary percutaneous coronary intervention, circulating PCSK9 was associated with lower LVEF at 6 months.CONCLUSIONSIn patients with a first STEMI with reduced ejection fraction at index admission and treated with primary percutaneous coronary intervention, circulating PCSK9 was associated with lower LVEF at 6 months. Proprotein convertase subtilisin/kexin type 9 (PCSK9) has emerged as a therapeutic target for reducing plasma low-density lipoprotein cholesterol. Beyond lipid control, recent findings suggest a deleterious effect of this protein in the pathogenesis of postmyocardial infarction left ventricle remodelling and heart failure-related complications. The aim of this study was to assess the relationship between circulating PCSK9 and 6 month cardiac magnetic resonance imaging-derived left ventricular ejection fraction (LVEF) after a first ST-segment elevation myocardial infarction (STEMI). We prospectively evaluated 40 patients with a first STEMI, LVEF < 50% and treated with primary percutaneous coronary intervention in which PCSK9 was measured 24 h postreperfusion. All patients underwent cardiac magnetic resonance imaging 1 week and 6 months after STEMI. Baseline characteristics were compared across median values of PCSK9. The association between PCSK9 levels and LVEF at 6 months was evaluated by analysis of covariance. The mean age of the sample was 60 ± 12 years and 33 (82.5%) were male patients. The infarct location was anterior in 27 patients (67.5%), and 9 patients (22.5%) were Killip class ≥ II. The mean 1 week and 6 month LVEF were 41 ± 7% and 48 ± 10%, respectively. The mean PCSK9 was 1.93 ± 0.38 U/mL. Testing the association between serum PCSK9 and 6 month LVEF with analysis of covariance revealed an inverse relationship (r = -0.35, P = 0.028). After multivariate adjustment, circulating PCSK9 remained significant and inversely associated with 6 month LVEF (P = 0.002). In patients with a first STEMI with reduced ejection fraction at index admission and treated with primary percutaneous coronary intervention, circulating PCSK9 was associated with lower LVEF at 6 months. AimsProprotein convertase subtilisin/kexin type 9 (PCSK9) has emerged as a therapeutic target for reducing plasma low‐density lipoprotein cholesterol. Beyond lipid control, recent findings suggest a deleterious effect of this protein in the pathogenesis of postmyocardial infarction left ventricle remodelling and heart failure‐related complications. The aim of this study was to assess the relationship between circulating PCSK9 and 6 month cardiac magnetic resonance imaging‐derived left ventricular ejection fraction (LVEF) after a first ST‐segment elevation myocardial infarction (STEMI).Methods and resultsWe prospectively evaluated 40 patients with a first STEMI, LVEF < 50% and treated with primary percutaneous coronary intervention in which PCSK9 was measured 24 h postreperfusion. All patients underwent cardiac magnetic resonance imaging 1 week and 6 months after STEMI. Baseline characteristics were compared across median values of PCSK9. The association between PCSK9 levels and LVEF at 6 months was evaluated by analysis of covariance. The mean age of the sample was 60 ± 12 years and 33 (82.5%) were male patients. The infarct location was anterior in 27 patients (67.5%), and 9 patients (22.5%) were Killip class ≥ II. The mean 1 week and 6 month LVEF were 41 ± 7% and 48 ± 10%, respectively. The mean PCSK9 was 1.93 ± 0.38 U/mL. Testing the association between serum PCSK9 and 6 month LVEF with analysis of covariance revealed an inverse relationship (r = −0.35, P = 0.028). After multivariate adjustment, circulating PCSK9 remained significant and inversely associated with 6 month LVEF (P = 0.002).ConclusionsIn patients with a first STEMI with reduced ejection fraction at index admission and treated with primary percutaneous coronary intervention, circulating PCSK9 was associated with lower LVEF at 6 months. Abstract Aims Proprotein convertase subtilisin/kexin type 9 (PCSK9) has emerged as a therapeutic target for reducing plasma low‐density lipoprotein cholesterol. Beyond lipid control, recent findings suggest a deleterious effect of this protein in the pathogenesis of postmyocardial infarction left ventricle remodelling and heart failure‐related complications. The aim of this study was to assess the relationship between circulating PCSK9 and 6 month cardiac magnetic resonance imaging‐derived left ventricular ejection fraction (LVEF) after a first ST‐segment elevation myocardial infarction (STEMI). Methods and results We prospectively evaluated 40 patients with a first STEMI, LVEF < 50% and treated with primary percutaneous coronary intervention in which PCSK9 was measured 24 h postreperfusion. All patients underwent cardiac magnetic resonance imaging 1 week and 6 months after STEMI. Baseline characteristics were compared across median values of PCSK9. The association between PCSK9 levels and LVEF at 6 months was evaluated by analysis of covariance. The mean age of the sample was 60 ± 12 years and 33 (82.5%) were male patients. The infarct location was anterior in 27 patients (67.5%), and 9 patients (22.5%) were Killip class ≥ II. The mean 1 week and 6 month LVEF were 41 ± 7% and 48 ± 10%, respectively. The mean PCSK9 was 1.93 ± 0.38 U/mL. Testing the association between serum PCSK9 and 6 month LVEF with analysis of covariance revealed an inverse relationship (r = −0.35, P = 0.028). After multivariate adjustment, circulating PCSK9 remained significant and inversely associated with 6 month LVEF (P = 0.002). Conclusions In patients with a first STEMI with reduced ejection fraction at index admission and treated with primary percutaneous coronary intervention, circulating PCSK9 was associated with lower LVEF at 6 months. Aims Proprotein convertase subtilisin/kexin type 9 (PCSK9) has emerged as a therapeutic target for reducing plasma low‐density lipoprotein cholesterol. Beyond lipid control, recent findings suggest a deleterious effect of this protein in the pathogenesis of postmyocardial infarction left ventricle remodelling and heart failure‐related complications. The aim of this study was to assess the relationship between circulating PCSK9 and 6 month cardiac magnetic resonance imaging‐derived left ventricular ejection fraction (LVEF) after a first ST‐segment elevation myocardial infarction (STEMI). Methods and results We prospectively evaluated 40 patients with a first STEMI, LVEF < 50% and treated with primary percutaneous coronary intervention in which PCSK9 was measured 24 h postreperfusion. All patients underwent cardiac magnetic resonance imaging 1 week and 6 months after STEMI. Baseline characteristics were compared across median values of PCSK9. The association between PCSK9 levels and LVEF at 6 months was evaluated by analysis of covariance. The mean age of the sample was 60 ± 12 years and 33 (82.5%) were male patients. The infarct location was anterior in 27 patients (67.5%), and 9 patients (22.5%) were Killip class ≥ II. The mean 1 week and 6 month LVEF were 41 ± 7% and 48 ± 10%, respectively. The mean PCSK9 was 1.93 ± 0.38 U/mL. Testing the association between serum PCSK9 and 6 month LVEF with analysis of covariance revealed an inverse relationship (r = −0.35, P = 0.028). After multivariate adjustment, circulating PCSK9 remained significant and inversely associated with 6 month LVEF (P = 0.002). Conclusions In patients with a first STEMI with reduced ejection fraction at index admission and treated with primary percutaneous coronary intervention, circulating PCSK9 was associated with lower LVEF at 6 months. Aims Proprotein convertase subtilisin/kexin type 9 (PCSK9) has emerged as a therapeutic target for reducing plasma low‐density lipoprotein cholesterol. Beyond lipid control, recent findings suggest a deleterious effect of this protein in the pathogenesis of postmyocardial infarction left ventricle remodelling and heart failure‐related complications. The aim of this study was to assess the relationship between circulating PCSK9 and 6 month cardiac magnetic resonance imaging‐derived left ventricular ejection fraction (LVEF) after a first ST‐segment elevation myocardial infarction (STEMI). Methods and results We prospectively evaluated 40 patients with a first STEMI, LVEF < 50% and treated with primary percutaneous coronary intervention in which PCSK9 was measured 24 h postreperfusion. All patients underwent cardiac magnetic resonance imaging 1 week and 6 months after STEMI. Baseline characteristics were compared across median values of PCSK9. The association between PCSK9 levels and LVEF at 6 months was evaluated by analysis of covariance. The mean age of the sample was 60 ± 12 years and 33 (82.5%) were male patients. The infarct location was anterior in 27 patients (67.5%), and 9 patients (22.5%) were Killip class ≥ II. The mean 1 week and 6 month LVEF were 41 ± 7% and 48 ± 10%, respectively. The mean PCSK9 was 1.93 ± 0.38 U/mL. Testing the association between serum PCSK9 and 6 month LVEF with analysis of covariance revealed an inverse relationship (r = −0.35, P = 0.028). After multivariate adjustment, circulating PCSK9 remained significant and inversely associated with 6 month LVEF (P = 0.002). Conclusions In patients with a first STEMI with reduced ejection fraction at index admission and treated with primary percutaneous coronary intervention, circulating PCSK9 was associated with lower LVEF at 6 months. |
| Author | Miñana, Gema Ríos‐Navarro, César Chorro, Francisco J. Monmeneu, Jose Vicente Bodí, Vicent Revuelta‐López, Elena Núñez, Julio López‐Lereu, Maria Pilar Bayés‐Genís, Antoni Núñez, Eduardo Lupón, Josep Sanchis, Juan |
| AuthorAffiliation | 4 ERESA Valencia Spain 3 Cardiology Department and Heart Failure Unit Hospital Universitari Germans Trias i Pujol Badalona, Spain Department of Medicine Universitat Autonoma de Barcelona Barcelona Spain 2 CIBER Cardiovascular Madrid Spain 1 Cardiology Department Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València Valencia Spain |
| AuthorAffiliation_xml | – name: 2 CIBER Cardiovascular Madrid Spain – name: 1 Cardiology Department Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València Valencia Spain – name: 3 Cardiology Department and Heart Failure Unit Hospital Universitari Germans Trias i Pujol Badalona, Spain Department of Medicine Universitat Autonoma de Barcelona Barcelona Spain – name: 4 ERESA Valencia Spain |
| Author_xml | – sequence: 1 givenname: Gema surname: Miñana fullname: Miñana, Gema organization: CIBER Cardiovascular – sequence: 2 givenname: Julio surname: Núñez fullname: Núñez, Julio organization: CIBER Cardiovascular – sequence: 3 givenname: Antoni surname: Bayés‐Genís fullname: Bayés‐Genís, Antoni email: abayesgenis@gmail.com organization: Universitat Autonoma de Barcelona – sequence: 4 givenname: Elena surname: Revuelta‐López fullname: Revuelta‐López, Elena organization: Universitat Autonoma de Barcelona – sequence: 5 givenname: César surname: Ríos‐Navarro fullname: Ríos‐Navarro, César organization: Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València – sequence: 6 givenname: Eduardo surname: Núñez fullname: Núñez, Eduardo organization: Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de València – sequence: 7 givenname: Francisco J. surname: Chorro fullname: Chorro, Francisco J. organization: CIBER Cardiovascular – sequence: 8 givenname: Maria Pilar surname: López‐Lereu fullname: López‐Lereu, Maria Pilar organization: ERESA – sequence: 9 givenname: Jose Vicente surname: Monmeneu fullname: Monmeneu, Jose Vicente organization: ERESA – sequence: 10 givenname: Josep surname: Lupón fullname: Lupón, Josep organization: Universitat Autonoma de Barcelona – sequence: 11 givenname: Juan surname: Sanchis fullname: Sanchis, Juan organization: CIBER Cardiovascular – sequence: 12 givenname: Vicent surname: Bodí fullname: Bodí, Vicent email: vicentbodi@hotmail.com organization: CIBER Cardiovascular |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31903686$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_3389_fphys_2020_598649 crossref_primary_10_1007_s00395_020_00832_w crossref_primary_10_15829_1560_4071_2023_5201 crossref_primary_10_3390_jcm10132968 crossref_primary_10_15829_1560_4071_20245743 crossref_primary_10_1002_ejhf_2932 crossref_primary_10_3390_biomedicines9070793 crossref_primary_10_1177_1721727X221107232 crossref_primary_10_1007_s00395_020_00824_w crossref_primary_10_1016_j_metabol_2024_156064 crossref_primary_10_1186_s12944_022_01672_4 crossref_primary_10_17816_clinpract48893 |
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| Copyright | 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology. 2020. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the "License"). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2020. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. |
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| Keywords | PCSK9 ST-segment elevation myocardial infarction Left ventricular ejection fraction Cardiac magnetic resonance |
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| License | Attribution-NonCommercial 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Gema Miñana and Julio Núñez contributed similarly in the present study. “All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation”. |
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| References_xml | – volume: 270 start-page: 336 year: 2018 end-page: 342 article-title: ST2 and left ventricular remodeling after ST‐segment elevation myocardial infarction: a cardiac magnetic resonance study publication-title: Int J Cardiol – volume: 22 start-page: 760 year: 2015 end-page: 771 article-title: Hemodynamic shear stress via ROS modulates PCSK9 expression in human vascular endothelial and smooth muscle cells and along the mouse aorta publication-title: Antioxid Redox Signal – volume: 8 start-page: 2267 year: 2018 article-title: PCSK9 induces a pro‐inflammatory response in macrophages publication-title: Sci Rep – volume: 107 start-page: 556 year: 2015 end-page: 567 article-title: Cross‐talk between LOX‐1 and PCSK9 in vascular tissues publication-title: Cardiovasc Res – volume: 4 start-page: 174 year: 2016 article-title: Multivariable fractional polynomial method for regression model publication-title: Ann Transl Med – volume: 25 start-page: 997 year: 2016 end-page: 1008 article-title: Crosstalk between PCSK9 and damaged mtDNA in vascular smooth muscle cells: role in apoptosis publication-title: Antioxid Redox Signal – volume: 114 start-page: 1738 year: 2018 end-page: 1751 article-title: PCSK9 expression in the ischemic heart and its relationship to infarct size, cardiac function and development of autophagy publication-title: Cardiovasc Res – volume: 70 start-page: 2128 year: 2017 end-page: 2136 article-title: The PCSK9‐LDL receptor axis and outcomes in heart failure: BIOSTAT‐CHF subanalysis publication-title: J Am Coll Cardiol – volume: 30 start-page: 931 year: 2012 end-page: 938 article-title: PCSK9 siRNA suppresses the inflammatory response induced by oxLDL through inhibition of NF‐kappa B activation in THP‐1‐derived macrophages publication-title: Int J Mol Med – volume: 6 start-page: 258ra143 year: 2014 article-title: PCSK9 is a critical regulator of the innate immune response and septic shock outcome publication-title: Sci Transl Med – volume: 221 start-page: 3 year: 2010 end-page: 12 article-title: Autophagy: cellular and molecular mechanisms publication-title: J Pathol – volume: 9 year: 2014 article-title: Homogenous 96‐plex PEA immunoassay exhibiting high sensitivity, specificity, and excellent scalability publication-title: PLoS ONE – volume: 164 start-page: 600 year: 2016 end-page: 607 article-title: Proprotein convertase subtilisin/kexin type 9 monoclonal antibodies for acute coronary syndrome: a narrative review publication-title: Ann Intern Med – volume: 376 start-page: 1713 year: 2017 end-page: 1722 article-title: Evolocumab and clinical outcomes in patients with cardiovascular disease publication-title: N Engl J Med – volume: 278 start-page: 54 year: 2016 end-page: 63 article-title: Prediction of reverse remodeling at cardiac MR imaging soon after first ST‐segment‐elevation myocardial infarction: results of a large prospective registry publication-title: Radiology – ident: e_1_2_10_9_1 doi: 10.21037/atm.2016.05.01 – ident: e_1_2_10_11_1 doi: 10.1089/ars.2016.6631 – ident: e_1_2_10_13_1 doi: 10.1038/s41598-018-20425-x – ident: e_1_2_10_2_1 doi: 10.1056/NEJMoa1615664 – ident: e_1_2_10_14_1 doi: 10.1126/scitranslmed.3008782 – ident: e_1_2_10_3_1 doi: 10.1089/ars.2014.6054 – ident: e_1_2_10_6_1 doi: 10.1148/radiol.2015142674 – ident: e_1_2_10_10_1 doi: 10.7326/M15-2994 – ident: e_1_2_10_7_1 doi: 10.1016/j.ijcard.2018.06.073 – ident: e_1_2_10_12_1 doi: 10.1093/cvr/cvv178 – ident: e_1_2_10_8_1 doi: 10.1371/journal.pone.0095192 – ident: e_1_2_10_16_1 doi: 10.1002/path.2697 – ident: e_1_2_10_15_1 doi: 10.3892/ijmm.2012.1072 – ident: e_1_2_10_5_1 doi: 10.1016/j.jacc.2017.08.057 – ident: e_1_2_10_4_1 doi: 10.1093/cvr/cvy128 |
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Proprotein convertase subtilisin/kexin type 9 (PCSK9) has emerged as a therapeutic target for reducing plasma low‐density lipoprotein cholesterol. Beyond... Proprotein convertase subtilisin/kexin type 9 (PCSK9) has emerged as a therapeutic target for reducing plasma low-density lipoprotein cholesterol. Beyond lipid... Aims Proprotein convertase subtilisin/kexin type 9 (PCSK9) has emerged as a therapeutic target for reducing plasma low‐density lipoprotein cholesterol. Beyond... AimsProprotein convertase subtilisin/kexin type 9 (PCSK9) has emerged as a therapeutic target for reducing plasma low‐density lipoprotein cholesterol. Beyond... Abstract Aims Proprotein convertase subtilisin/kexin type 9 (PCSK9) has emerged as a therapeutic target for reducing plasma low‐density lipoprotein... |
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| SubjectTerms | Age Autophagy Cardiac function Cardiac magnetic resonance Cytokines Ejection fraction Heart attacks Heart failure Left ventricular ejection fraction Original Original s PCSK9 Smooth muscle Studies ST‐segment elevation myocardial infarction |
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| Title | Role of PCSK9 in the course of ejection fraction change after ST‐segment elevation myocardial infarction: a pilot study |
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