Vroege evolocumab na hartinfarct verlaagt MACE bij uitgestelde randstenosen

BACKGROUND AND AIMS: The proprotein convertase subtilisin/kexin type 9 inhibitors, i.e. evolocumab, promote coronary plaque regression in patients with acute myocardial infarction (AMI). However, its clinical benefit for non-culprit intermediate lesions deferred for revascularization remains uncertain. This study evaluated whether early evolocumab initiation improves outcomes in this specific population. METHODS: Using target trial emulation to a multicenter registry of AMI patients in Shanghai (2021-2022), this study enrolled patients with successful culprit-vessel revascularization but ≥1 deferred non-culprit intermediate lesion. The intervention was evolocumab initiation during index hospitalization versus standard care alone. The primary outcome was a major adverse cardiac event (MACE) at 2 years. Treatment effects were estimated using the multivariable-adjusted Cox regression model, propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) to adjust for confounding. RESULTS: Among 1862 eligible patients (4034 lesions), 174 received evolocumab and 1688 did not. The evolocumab group exhibited a higher baseline cardiovascular risk profile, including elevated LDL-C (126.8 vs. 87.8 mg/dL; p < 0.001). Over 2 years, MACE occurred in 5.9% of evolocumab-treated lesions compared with 11.9% in controls. While the hazard ratio (HR) for the full 2-year period was 0.72 (95% CI 0.48-1.09), a landmark analysis at 30 days demonstrated a significant reduction in MACE risk (HR 0.35; 95% CI 0.16-0.74). Results were consistent across PSM and IPTW adjustments. CONCLUSIONS: In AMI patients with deferred non-culprit lesions, early initiation of evolocumab was associated with a significant reduction in early MACE, driven by benefits within 30 days post-discharge.