Key result
Early evolocumab suppresses post-MI Lp(a) increases by an absolute ~86% versus statin alone.
Why the study?
This study sought to investigate the effect of early initiation of evolocumab on lipoprotein(a) based on baseline lipoprotein(a) levels and patient characteristics after primary PCI for AMI.
Does early initiation of evolocumab reduce lipoprotein(a) levels in patients with acute myocardial infarction after primary PCI?
RCT (n=102)
Open-label (evaluators blinded)
Computer-generated random sequence web response system, 1:1 ratio, stratified by center using random permuted blocks
No
Does early initiation of evolocumab reduce lipoprotein(a) levels in patients with acute myocardial infarction after primary PCI?
Mean Difference: -86.3 (95% CI -134.5–-38)
Absolute Event Rate: -2.7% vs 82%
p-value: p=0.01
Early initiation of evolocumab within 24 hours of primary PCI for AMI effectively suppresses lipoprotein(a) levels at 4 weeks regardless of baseline levels.
Supports early evolocumab addition post-AMI for Lp(a) control; extends PCSK9 evidence to acute phase and warrants outcome trials.
Elevated circulating lipoprotein(a) levels are associated with an increased risk of cardiovascular events. We reported that early initiation of evolocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, in addition to a statin substantially reduced the lipoprotein(a) levels in patients with acute myocardial infarction (AMI) after primary percutaneous coronary intervention (PCI). This sub-analysis sought to investigate the effect of evolocumab on lipoprotein(a) based on baseline lipoprotein(a) levels and characteristics. This study was a prespecified analysis of a randomized controlled trial that enrolled 102 patients who underwent primary PCI for AMI. Patients received pitavastatin (2 mg/day) alone or pitavastatin and evolocumab 140 mg subcutaneously within 24 h and 2 weeks after the index PCI. The evolocumab group showed significantly suppressed lipoprotein(a) levels in patients with baseline lipoprotein(a) levels of ≤10 mg/dL, 10 < lipoprotein(a) ≤ 20 mg/dL, and >20 mg/dL compared with the control group, as well as similar reductions in lipoprotein(a) levels in all patient subgroups. Among these subgroups, evolocumab tended to show more favorable effects in patients with diabetes mellitus. In AMI patients, early initiation of evolocumab therapy within 24 h of primary PCI suppressed the increase in lipoprotein(a) levels within 4 weeks, regardless of baseline levels and characteristics.
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Okada et al. (2022) conducted an RCT in Acute myocardial infarction (AMI) (n=102). Evolocumab combined with pitavastatin vs. Pitavastatin 2 mg/day alone was evaluated on Change in lipoprotein(a) levels from baseline to 4 weeks (MD -86.3%, 95% CI -134.5% to -38.0%, p=0.01). Early initiation of evolocumab combined with pitavastatin significantly suppressed the increase in lipoprotein(a) levels at 4 weeks following acute myocardial infarction compared to pitavastatin alone (mean difference -86.3%).
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