Using PCSK9i in Patients Post ACS

The conversation shifts toward practical implementation of inclisiran in clinical settings, focusing on patient selection and systemic integration. Despite knowing that rapid low-density lipoprotein (LDL) reduction after an acute coronary syndrome (ACS) event significantly lowers risk, barriers such as insurance policies and current clinical guidelines make it difficult to start patients on multiple lipid-lowering agents up front. However, the VICTORION-INCEPTION study supports the early use of inclisiran, especially in patients with ACS, as a strategy to close the gap between clinical evidence and real-world outcomes. Administering therapy during hospitalization, when patients are most receptive and motivated, may improve adherence and long-term success.

Experts emphasize the need for a new care model—one that shifts from reactive, physician-dependent interventions to a more uniform, system-driven strategy. Rather than waiting for patients to cycle through treatment failures, health systems could proactively initiate therapies like inclisiran in all qualifying patients with atherosclerotic cardiovascular disease. Given inclisiran’s biannual administration and consistent LDL-lowering efficacy, it is an ideal candidate for centralized lipid management programs, especially in integrated health care settings. Such an approach could streamline care, ensure adherence, and reduce provider burden, ultimately standardizing treatment quality across populations.

The dialogue also draws comparisons to successful heart failure care models, where simultaneous initiation of multiple guideline-directed therapies is common. As access to physicians tightens and the number of practicing clinicians declines, cardiology must adapt by making guidelines more pragmatic and reflective of real-world constraints. Waiting months to achieve LDL targets isn’t viable—especially in high-risk patients post ACS event. Inclisiran offers a timely, scalable solution to this longstanding challenge in cardiovascular prevention.