{"id":"291fbfea9ebd","type":"article","url":"https://hartvaat.nl/2019/11/19/evolocumab-voor-vroege-ldl-verlaging-bij-acs-evopacs/","title":"Evolocumab voor vroege LDL-verlaging bij ACS: EVOPACS","title_en":"Evolocumab for Early Reduction of LDL Cholesterol Levels in Patients With Acute Coronary Syndromes (EVOPACS).","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["bempedoïnezuur","dyslipidemie","ezetimibe","ldl-cholesterol","lipide-aferese","lipidenverlaging","statines","yellow-iii"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2019.08.010","source_url":"https://doi.org/10.1016/j.jacc.2019.08.010","authors":["Konstantinos C Koskinas","Stephan Windecker","Giovanni Pedrazzini","Christian Mueller","Stéphane Cook","Christian M Matter","Olivier Muller","Jonas Häner","Baris Gencer","Carmela Crljenica","Poorya Amini","Olga Deckarm","Juan F Iglesias","Lorenz Räber","Dik Heg","François Mach"],"significance":7,"published":"2019-11-19","source_date":"2019-11-19","image":"","kennis":[],"congress":"","summary_en":"The EVOPACS study showed that early in-hospital initiation of evolocumab in ACS patients produces rapid and substantial LDL cholesterol reduction within days, establishing the feasibility and efficacy of PCSK9 inhibition in the acute setting.","created":"2026-07-03T10:28:16Z","updated":"2026-07-03T13:27:27Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"EVOPACS studie naar vroege evolocumab-toediening bij ACS voor snelle LDL-cholesterolreductie in de acute fase.","abstract_original":"BACKGROUND: Although guidelines recommend in-hospital initiation of high-intensity statin therapy in patients with acute coronary syndromes (ACS), low-density lipoprotein cholesterol (LDL-C) target levels are frequently not attained. Evolocumab, a rapidly acting, potent LDL-C-lowering drug, has not been studied in the acute phase of ACS. OBJECTIVES: The purpose of this study was to assess the feasibility, safety, and LDL-C-lowering efficacy of evolocumab initiated during the in-hospital phase of ACS. METHODS: The authors conducted an investigator-initiated, randomized, double-blind, placebo-controlled trial involving 308 patients hospitalized for ACS with elevated LDL-C levels (≥1.8 mmol/l on high-intensity statin for at least 4 weeks; ≥2.3 mmol/l on low- or moderate-intensity statin; or ≥3.2 mmol/l on no stable dose of statin). Patients were randomly assigned 1:1 to receive subcutaneous evolocumab 420 mg or matching placebo, administered in-hospital and after 4 weeks, on top of atorvastatin 40 mg. The primary endpoint was percentage change in calculated LDL-C from baseline to 8 weeks. RESULTS: Most patients (78.2%) had not been on previous statin treatment. Mean LDL-C levels decreased from 3.61 to 0.79 mmol/l at week 8 in the evolocumab group, and from 3.42 to 2.06 mmol/l in the placebo group; the difference in mean percentage change from baseline was -40.7% (95% confidence interval: -45.2 to -36.2; p < 0.001). LDL-C levels <1.8 mmol/l were achieved at week 8 by 95.7% of patients in the evolocumab group versus 37.6% in the placebo group. Adverse events and centrally adjudicated cardiovascular events were similar in both groups. CONCLUSIONS: In this first randomized trial assessing a PCSK9 antibody in the very high-risk setting of ACS, evolocumab added to high-intensity statin therapy was well tolerated and resulted in substantial reduction in LDL-C levels, rendering >95% of patients within currently recommended target levels. (EVOlocumab for Early Reduction of LDL-cholesterol Levels in Patients With Acute Coronary Syndromes [EVOPACS]; NCT03287609)."}