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Updated: Sep 4, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Evolocumab for prevention of microvascular dysfunction in patients undergoing percutaneous coronary intervention: the
Masaharu Ishihara1, Masanori Asakura1,2, Kiyoshi Hibi3
1Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Hyogo, Japan.
Insights
Evolocumab pretreatment did not prevent periprocedural microvascular dysfunction in patients undergoing percutaneous coronary intervention (PCI) who were already on statin therapy. This study found no significant difference in microvascular resistance or myocardial injury markers between groups.
Area of Science:
- Cardiology
- Pharmacology
- Interventional Cardiology
Background:
- Statins are known to prevent microvascular dysfunction post-percutaneous coronary intervention (PCI).
- Evolocumab offers more potent lipid-lowering effects compared to statins.
- Investigating novel therapies to mitigate PCI-related complications is crucial.
Purpose of the Study:
- To determine if evolocumab pretreatment, in addition to statin therapy, can prevent periprocedural microvascular dysfunction.
- To assess the impact of evolocumab on microvascular resistance and myocardial injury markers after PCI.
- To evaluate the efficacy of adding evolocumab to statins for preventing PCI complications.
Main Methods:
- A randomized controlled trial involving 100 patients with stable coronary artery disease undergoing PCI.
- Patients received either evolocumab pretreatment plus statins or statins alone (control group).
- Primary endpoint was the index of microvascular resistance (IMR) post-PCI; Troponin T levels were also measured.
Main Results:
- No significant difference in the index of microvascular resistance (IMR) between the evolocumab and control groups (p=0.98).
- Post-PCI Troponin T levels and the incidence of major periprocedural myocardial infarction were similar in both groups (p=0.99 and p=1.00, respectively).
- Evolocumab significantly reduced LDL-C levels before PCI compared to the control group.
Conclusions:
- Evolocumab pretreatment did not offer additional benefit in preventing periprocedural microvascular dysfunction in patients already managed with statins.
- The findings suggest that current statin therapy may be sufficient in managing microvascular dysfunction in this patient population.
- Further research may explore different patient subsets or treatment durations for evolocumab's potential benefits.
Background:
Statins have been shown to prevent microvascular dysfunction that may cause periprocedural myocardial infarction after percutaneous coronary intervention (PCI). Evolocumab has more potent lipid-lowering properties than statins. Aims: The aims of this study were to investigate whether evolocumab pretreatment on top of statin therapy could prevent periprocedural microvascular dysfunction. Methods: This study included 100 patients with stable coronary artery disease who were scheduled to undergo PCI and had high low-density lipoprotein cholesterol (LDL-C) under statin therapy. Patients were randomised to receive evolocumab 140 mg every 2 weeks for 2 to 6 weeks before PCI (evolocumab group: N=54) or not (control group: N=46). The primary endpoint was the index of microvascular resistance (IMR) after PCI. Troponin T was measured before and 24 hours after PCI. Results: Geometric mean LDL-C was 94.1 (95% confidence interval [CI]: 86.8-102.1) mg/dl and 89.4 (95% CI: 83.5-95.7) mg/dl at baseline, and 25.6 (95% CI: 21.9-30.0) mg/dl and 79.8 (95% CI: 73.9-86.3) mg/dl before PCI, in the evolocumab group and in the control group, respectively. PCI was performed 22.1±8.5 days after allocation. Geometric mean IMR was 20.6 (95% CI: 17.2-24.6) in the evolocumab group and 20.6 (95% CI: 17.0-25.0) in the control group (p=0.98). There was no significant difference in the geometric mean of post-PCI troponin T (0.054, 95% CI: 0.041-0.071 ng/ml vs 0.054, 95% CI: 0.038-0.077 ng/ml; p=0.99) and in the incidence of major periprocedural myocardial infarction between the 2 groups (44.4% vs 44.2%; p=1.00). Conclusions: Evolocumab pretreatment did not prevent periprocedural microvascular dysfunction in patients on modern medical management with statins.
