Early evolocumab improves lipid profile, inflammation and short-term outcomes in non-revascularized CHIP-NSTEACS...

To evaluate the lipid-lowering efficacy, anti-inflammatory activity, and short-term prognostic benefit of early evolocumab plus statin in complex high-risk indicated non-revascularized non-ST-elevation acute coronary syndrome (CHIP-NSTEACS) patients.

This single-center retrospective cohort study consecutively enrolled 186 CHIP-NSTEACS patients hospitalized from January 2022 to December 2024. Patients were divided into an observation group (high-intensity statin + evolocumab initiated within 48 h of admission, n = 92) and a control group (statin monotherapy, n = 94). Inverse probability of treatment weighting (IPTW) was used to balance baseline covariates. Longitudinal changes in lipid profiles and high-sensitivity C-reactive protein (hs-CRP) were analyzed using repeated-measures ANOVA. The primary endpoint was 3-month major adverse cardiovascular events (MACE). Multivariate Cox regression and Fine-Gray competing risk models were used for survival analysis.

Baseline characteristics were well-balanced after IPTW (all standardized mean differences <0.1). At 3 months, LDL-C reduction was 61.3% in the observation group vs. 32.2% in the control group (P < 0.001), with target achievement rates (<1.8 mmol/L) of 89.1% vs. 27.7% (P < 0.001). Evolocumab also significantly reduced lipoprotein(a) and hs-CRP (48.7% vs. 26.1% at 1 month, P < 0.001). The 3-month MACE incidence was lower in the observation group (11.96% vs. 28.72%, P = 0.004), driven by reductions in non-fatal myocardial infarction, recurrent angina, and unplanned cardiac rehospitalization. Multivariate Cox regression identified early evolocumab as an independent protective factor against 3-month MACE (HR = 0.42, 95% CI: 0.25-0.71, P = 0.001). No significant between-group difference in adverse events was observed (5.43% vs. 4.26%, P = 0.715).

Early evolocumab add-on therapy to high-intensity statin achieves potent lipid-lowering and anti-inflammatory effects, improves 3-month clinical outcomes, and has an acceptable safety profile in non-revascularized CHIP-NSTEACS patients. This strategy represents a promising optimized pharmacotherapy for this ultra-high-risk population.

Single-center retrospective design and short follow-up period limit generalizability.