Acute Myocardial Infarction from Stent Thrombosis Following a Loss to Follow-up Triggered by Financial Barriers to...

Area of Science:

• Cardiology
• Pharmacoeconomics
• Interventional Cardiology

Background:

• Familial hypercholesterolemia (FH) requires aggressive lipid-lowering therapy.
• PCSK9 inhibitors offer significant cardiovascular risk reduction but can be costly.
• Adherence to long-term medical therapy is crucial for preventing major adverse cardiovascular events.

Purpose of the Study:

• To highlight the critical role of financial feasibility in the long-term success of PCSK9 inhibitor therapy.
• To underscore the potential consequences of treatment discontinuation due to cost.
• To emphasize the importance of shared decision-making in managing complex cardiovascular conditions.

Main Methods:

• Case report of a patient with familial hypercholesterolemia undergoing percutaneous coronary intervention (PCI).
• Initiation and subsequent discontinuation of a PCSK9 inhibitor due to financial constraints.
• Follow-up assessment revealing the development of stent thrombosis and ST-elevation myocardial infarction.
• Emergency PCI with mechanical circulatory support (Impella) for revascularization.

Main Results:

• The patient experienced stent thrombosis four years after discontinuing PCSK9 inhibitor therapy due to financial issues.
• ST-elevation myocardial infarction (STEMI) with cardiogenic shock necessitated emergency revascularization.
• Successful revascularization was achieved with Impella support during PCI.
• The case illustrates a link between therapy cost, adherence, and long-term cardiovascular outcomes.

Conclusions:

• Clinical efficacy of advanced therapies like PCSK9 inhibitors must be balanced with financial feasibility.
• Patient financial constraints and adherence challenges are critical factors in long-term cardiovascular disease management.
• Shared decision-making is essential to ensure sustainable and effective treatment plans for patients with hypercholesterolemia.