Acute Myocardial Infarction from Stent Thrombosis Following a Loss to Follow-up Triggered by Financial Barriers to PCSK9 Inhibitor Therapy

A 44-year-old man with suspected familial hypercholesterolemia underwent percutaneous coronary intervention (PCI) with bioresorbable polymer sirolimus-eluting stent implantation for unstable angina. A proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor was initiated post-procedure but it discontinued five months later due to financial constraints, leading to a loss to follow-up and cessation of optimal medical therapy, including antiplatelet therapy. Four years later, he developed stent thrombosis, presenting as ST-elevation myocardial infarction with cardiogenic shock. Emergency PCI with Impella support achieved successful revascularization. This case emphasizes that beyond clinical efficacy, attention to financial feasibility and shared decision-making is essential for the long-term success of therapies such as PCSK9 inhibitors.