Preoperative evolocumab-rosuvastatin significantly reduced angina incidence to 7.5% compared to 27.5% in control at 6 months (P = 0.037).
Does preoperative evolocumab combined with rosuvastatin reduce major adverse cardiovascular events at 6 months in patients with acute STEMI undergoing emergency PCI?
Preoperative administration of evolocumab and rosuvastatin in STEMI patients undergoing emergency PCI did not significantly reduce 6-month MACEs but accelerated LDL-C lowering, reduced angina, and improved myocardial reperfusion.
Absolute Event Rate: 0% vs 0%
Background The impact of single-dose preoperative evolocumab combined with rosuvastatin therapy prior to emergency percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI) remains insufficiently characterized within current guideline-directed medical therapy. Methods In this prospective randomized trial conducted at Liaocheng People’s Hospital (2023–2024), 80 STEMI patients undergoing emergency PCI were randomized to: Treatment group: Single subcutaneous evolocumab 140 mg plus oral rosuvastatin 10 mg administered pre-PCI, followed by rosuvastatin 10 mg/day; Control group: Rosuvastatin 10 mg/day alone initiated post-PCI. Primary endpoint was major adverse cardiovascular events (MACEs) at 6 months. Secondary endpoints included angina incidence, low-density lipoprotein cholesterol (LDL-C) levels, interleukins, and ST-segment resolution rate (STR). The trial was registered at the Chinese Clinical Trial Registry (ChiCTR2500099498). Results Primary endpoint (MACEs): 5.0% (treatment group) vs. 12.5% (control group)(P = 0.228) at 6-month follow-up. Secondary endpoints: Angina incidence: 7.5% vs 27.5% (P = 0.037) at 6-month follow-up; LDL-C reduction: Significant in treatment group at day 1 (2.97 ± 0.63 vs 3.33 ± 0.78 mmol/L; P = 0.029), day 7 (1.66 ± 0.89 vs 2.25 ± 0.77 mmol/L, P = 0.003), and month 1 (P = 0.036); ST-segment resolution >70%: 60% vs 30% (P < 0.05); Inflammatory markers: Lower IL-6 (P = 0.02) and IL-17 (P = 0.01) in treatment group. Conclusions While the evolocumab-rosuvastatin combination did not significantly reduce 6-month MACEs, it demonstrated clinically important benefits including reduced angina frequency, accelerated LDL-C lowering, improved myocardial reperfusion, and attenuated inflammatory response, with a favorable safety profile. These findings support further investigation of intensive lipid-lowering strategies in acute STEMI management.
Li et al. (Fri,) reported a other. Preoperative evolocumab-rosuvastatin significantly reduced angina incidence to 7.5% compared to 27.5% in control at 6 months (P = 0.037).