Background. In-hospital reduction of low-density lipoprotein cholesterol (LDL-C) levels following the acute coronary syndrome (ACS) is recommended in the current clinical guidelines. However, the efficacy of proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors (Evolocumab) in these patients undergoing surgical coronary revascularization has not been demonstrated.
Methods. From January 2022 to June 2023, we analyzed 74 patients presenting with ACS whose LDL-C levels were higher than guideline-recommended targets and underwent coronary bypass surgery. In the first period (January 2022- January 2023), the patients increased the Statin dosage and/or added Ezetimibe (Group STEZE 43 patients). At a later time (February 2023 – July 2023), the patients received not only Statin and ezetimibe but also evolocumab 140 mg every 2 weeks started as early as possible (Group STEVO 31 patients). One and three months after discharge the patients underwent a clinical and laboratory control with evaluation of the efficacy lipid measurements and every adverse event.
Results. The two groups not differ in terms of risk factors as mean age (STEVO: 68.5±6.8 y.o. vs. STEZE 70±7.4 y.o. p=0.38), Diabetes (STEVO: 12-38.7% vs. STEZE 18-41.8%, p=0.79), previous myocardial infarction (STEVO: 7-22.6% vs. STEZE 10-23.2%, p=0.91) and Euroscore II (STEVO: 2.14±0.75 vs. STEZE 2.05±0.6, p=0.29). Also in terms of ACS (ST-, Instable angina or NSTE) and time of symptom onset, there is no difference between groups. Most patients (74.4% in STEZE and 71% in STEVO, p=0.88) were on no statin at baseline. Cholesterol, LDL-C and HDL trends from preprocedural to 3 months follow up in both groups demonstrating a more significative reduction in LDL-C and Cholesterol in STEVO group and no difference in HDL-C raising. No deaths were reported. In 3 STEZE group a recurrence of angina poses the need of re-revascularization. No of STEVO patients occur one major adverse event. The statistic difference in terms of these serious events 7% in STEZE vs. 0% in STEVO was not significant (p=0.26).
Conclusions. Evolocumab initiated “as soon as possible” in ACS submitted to CABG with high-intensity statin therapy and ezetimibe was well tolerated and resulted in a substantial reduction in LDL-C levels at dismission, 1 and 3 months. This laboratory result is associated with a reduction in repeated-revascularization.
