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Interval From Initiation of Prasugrel to Coronary Angiography in Patients With Non–ST-Segment Elevation Myocardial Infarction Mortality in STEMI patients without standard modifiable risk factors: a sex-disaggregated analysis of SWEDEHEART registry data Correlation between frequency-domain optical coherence tomography and fractional flow reserve in angiographically-intermediate coronary lesions Effects of dapagliflozin on major adverse kidney and cardiovascular events in patients with diabetic and non-diabetic chronic kidney disease: a prespecified analysis from the DAPA-CKD trial Optical coherence tomography imaging during percutaneous coronary intervention impacts physician decision-making: ILUMIEN I study Reappraisal of Reported Genes for Sudden Arrhythmic Death: An Evidence-Based Evaluation of Gene Validity for Brugada Syndrome 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed Impact of Chronic Total Coronary Occlusion Location on Long-term Survival After Percutaneous Coronary Intervention Ticagrelor or Prasugrel in Patients with Acute Coronary Syndromes Effect of Smoking on Outcomes of Primary PCI in Patients With STEMI

Clinical Trial2020 Nov 11;S0735-1097(20)37776-7.

JOURNAL:J Am Coll Cardiol. Article Link

Effect of Evolocumab on Complex Coronary Disease Requiring Revascularization

K Oyama, RHM Furtado, BA Bergmark et al. Keywords: cholesterol; CABG; coronary revascularization; evolocumab; PCI

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BACKGROUND - Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors induce plaque regression and reduce the risk of coronary revascularization overall.


OBJECTIVES - To evaluate the ability of PCSK9 inhibitors to reduce the risk of complex coronary atherosclerosis requiring revascularization.


METHODS - FOURIER was a randomized trial of the PCSK9 inhibitor evolocumab vs. placebo in 27,564 patients with stable atherosclerosis on statin therapy followed for a median of 2.2 years. Clinical documentation of revascularization events was blindly reviewed to assess coronary anatomy and procedural characteristics. Complex revascularization was the composite of complex percutaneous coronary intervention (PCI) (as per previous analyses, >1 of: multivessel PCI, ≥3 stents, ≥3 lesions treated, bifurcation PCI, or total stent length >60 mm) or coronary artery bypass grafting surgery (CABG).


RESULTS - 1,724 patients underwent coronary revascularization, including 1482 who underwent PCI, 296 who underwent CABG, and 54 both. Complex revascularization was performed in 632 (37%) patients. Evolocumab reduced the risk of any coronary revascularization by 22% (HR 0.78 [0.71-0.86]; P<0.001), simple PCI by 22% (HR 0.78, [0.70-0.88]; P<0.001), complex PCI by 33% (HR 0.67 [0.54-0.84]; P<0.001), CABG by 24% (HR 0.76 [0.60-0.96]; P=0.019), and complex revascularization by 29% (HR 0.71 [0.61-0.84]; P<0.001). The magnitude of the risk reduction with evolocumab in complex revascularization tended to increase over time (20%, 36%, and 41% risk reductions in 1st, 2nd and beyond 2nd year).


CONCLUSIONS - Adding evolocumab to statin therapy significantly reduced the risk of developing complex coronary disease requiring revascularization, including complex PCI and CABG individually.