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Administration of Evolocumab in Patients with STEMI After Emergency PCI: A Real-World Cohort Study
Xuefeng Sun1,2, Shiru Bai2, Haibo Wu2
1Graduate School of Hebei Medical University, Shijiazhuang, China.
Insights
Evolocumab significantly reduced cardiovascular events and LDL-C in ST-segment elevation myocardial infarction patients after emergency percutaneous coronary intervention. This real-world study confirms its efficacy and safety in this high-risk group.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Evolocumab effectively lowers LDL-C and improves cardiovascular outcomes.
- Its impact on ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) is not well-established in real-world settings.
Purpose of the Study:
- To evaluate the efficacy and safety of evolocumab in STEMI patients post-emergency PCI using real-world clinical data.
- To assess the reduction in low-density lipoprotein cholesterol (LDL-C) and major adverse cardiovascular events (MACE).
Main Methods:
- Retrospective, single-center study of 384 STEMI patients undergoing emergency PCI.
- 85 patients received evolocumab plus standard of care (SOC); 299 received SOC alone.
- Propensity score matching (PSM) and inverse probability treatment weighting (IPTW) were used for covariate adjustment.
Main Results:
- Evolocumab + SOC significantly reduced the 18-month composite endpoint (HR=0.341, P=0.004 after PSM).
- Cumulative incidence of MACE was 12% with evolocumab + SOC vs. 32% with SOC alone.
- Significant LDL-C reductions were observed in the evolocumab group; no significant difference in adverse events.
Conclusions:
- Evolocumab plus SOC significantly reduces postoperative cardiovascular events in STEMI patients after emergency PCI.
- Evolocumab demonstrates a favorable safety profile and efficacy in lowering LDL-C in this specific patient population.
Background And Objective:
Evolocumab can reduce low-density lipoprotein cholesterol (LDL-C) levels and improve cardiovascular (CV) outcomes. While its benefits are well established in broader populations, its potential impact on patients with ST-segment elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI) remains underexplored, particularly in real-world settings. This study aimed to evaluate its efficacy and safety in this specific patient group on the basis of real-world clinical experience.
Methods:
A total of 384 patients with STEMI who underwent emergency PCI at Hebei General Hospital between 1 July 2021 and 23 September 2022 were enrolled in this retrospective, single-center study. Of these, 85 patients received evolocumab (140 mg every 2 weeks) plus standard of care (SOC), while 299 received SOC alone. Patients were monitored for CV events and lipid levels during follow-up. Propensity score matching (PSM) and inverse probability treatment weighting (IPTW) were used to balance covariates.
Results:
The experimental group had a lower cumulative incidence of the primary composite endpoint over 18 months in the unadjusted analysis (hazard ratio [HR] = 0.353; 95% confidence interval [CI] 0.180-0.693; P = 0.002), as well as after adjustment for PSM (HR = 0.341; 95% CI 0.165-0.706; P = 0.004) and IPTW (HR = 0.461; 95% CI 0.241-0.881; P = 0.019). The 18-month cumulative incidence was 10 (12%) for evolocumab + SOC and 95 (32%) for SOC. LDL-C levels in the evolocumab + SOC group showed significant reductions across different cohorts, compared with the SOC group. No significant differences in adverse events were observed between the two groups.
Conclusions:
Evolocumab plus SOC significantly reduced postoperative CV events and LDL-C levels in patients with STEMI after emergency PCI.
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