Highlights
- •Evolocumab showed better efficacy in patients with acute coronary syndrome
- •Evolocumab resulted in substantial reduction in LDL cholesterol levels
- •The benefits of evolocumab were consistent across the major subgroups
ABSTRACT
Purpose
Evolocumab has been shown to improve cardiovascular outcomes in patients with stable
atherosclerotic disease. Whether this benefit persists in patients with acute coronary
syndrome (ACS) undergoing percutaneous coronary intervention (PCI) remains undetermined.
This study aimed to evaluate the efficacy and safety of the early initiation of evolocumab
in Chinese patients with ACS undergoing PCI.
Methods
This retrospective cohort study involved 1564 consecutive patients who had been hospitalized
with ACS and underwent PCI, and who had elevated LDL-C levels (≥1.8 mmol/L after receiving
high-intensity statin therapy for ≥4 weeks; ≥2.3 mmol/L after receiving low- or moderate-intensity
statin; or ≥3.2 mmol/L without statin therapy). Patients who received evolocumab (initiated
in-hospital and after 18 months) were included in the evolocumab group (n = 414),
and all other patients were included in the control group (n = 1150). The primary
outcome at 18 months was a composite of ischemic stroke, cardiovascular death, myocardial
infarction, hospitalization for unstable angina, or coronary revascularization. The
evolocumab treatment effect on the primary outcome was assessed in all prespecified
subgroups.
Findings
At 18 months, evolocumab combined with statins reduced LDL-C levels from baseline
levels by 42.48% compared with statins alone. After multivariable adjustment, evolocumab
combined with statins significantly reduced the primary outcome (8.2% vs 12.4%; adjusted
hazard ratio, 0.65; 95% CI, 0.45–0.95; P = 0.025). In addition, evolocumab consistently reduced the primary outcome across
the major subgroups. For the safety outcomes, no significant differences between the
groups were observed in any adverse events.
Implications
Among Chinese patients who underwent PCI for ACS, the early initiation of evolocumab
combined with statin treatment effectively reduced LDL-C levels and lowered the incidence
of recurrent ischemic cardiovascular events, with satisfactory tolerability and safety.
Chinese Clinical Trial Registry identifier: ChiCTR2100049364.
Key words
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Article info
Publication history
Published online: May 14, 2022
Accepted:
April 22,
2022
Identification
Copyright
© 2022 Elsevier Inc.
