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. 2024 May 19;13(10):2987.
doi: 10.3390/jcm13102987.

Evolocumab Treatment in Dyslipidemic Patients Undergoing Coronary Artery Bypass Grafting: One-Year Safety and Efficacy Results

Giuseppe Nasso  1 , Walter Vignaroli  2 , Vincenzo Amodeo  3 , Francesco Bartolomucci  4 , Claudio Larosa  4 , Gaetano Contegiacomo  1 , Maria Antonietta Demola  1 , Cataldo Girasoli  1 , Antongiulio Valenzano  1 , Flavio Fiore  1 , Raffaele Bonifazi  1 , Vera Triggiani  1 , Vincenza Vitobello  1 , Giacomo Errico  1 , Angela Lamanna  1 , Dritan Hila  1 , Tommaso Loizzo  1 , Rosalba Franchino  1 , Stefano Sechi  2 , Giovanni Valenti  4 , Giuseppe Diaferia  5 , Mario Siro Brigiani  1 , Serena Arima  6 , Mario Angelelli  6 , Antonio Curcio  7 , Francesco Greco  8 , Ernesto Greco  9 , Giuseppe Speziale  1   2 , Giuseppe Santarpino  10   11   12
Affiliations

Evolocumab Treatment in Dyslipidemic Patients Undergoing Coronary Artery Bypass Grafting: One-Year Safety and Efficacy Results

Giuseppe Nasso et al. J Clin Med. .

Abstract

Background: The inhibition of PCSK9 lowered LDL cholesterol levels, reducing the risk of cardiovascular events. However, the effect on patients who have undergone surgical myocardial revascularization has not yet been evaluated. Methods: From January 2017 to December 2022, 180 dyslipidemic patients who underwent coronary artery bypass were included in the study. Until December 2019, 100 patients optimized therapy with statin ± ezetimibe (SG). Since January 2020, 80 matched patients added treatment with Evolocumab every 2 weeks (EG). All 180 patients were followed-up at 3 and 12 months, comparing outcomes. Results: The two groups are homogenous. At 3 months and 1 year, a significant decrease in the parameter mean levels of LDL cholesterol and total cholesterol is detected in the Evolocumab group compared to the standard group. No mortality was detected in either group. No complications or drug discontinuation were recorded. In the SG group, five patients (5%) suffered a myocardial infarction during the 1-year follow-up. In the EG group, two patients (2.5%) underwent PTCA due to myocardial infarction. There is no significant difference in overall survival according to the new treatment (p-value = 0.9), and the hazard ratio is equal to 0.94 (95% C.I.: [0.16-5.43]; p-value = 0.9397). Conclusions: The use of Evolocumab, which was started immediately after coronary artery bypass graft surgery, significantly reduced LDL cholesterol and total cholesterol levels compared to statin treatment alone and is completely safe. However, at one year of follow-up, this result did not have impact on the reduction in major clinical events.

Keywords: atherosclerosis; coronary artery bypass grafting; dyslipidemia.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study timeline.
Figure 2
Figure 2
(Left panel): Distribution of the cholesterol at different time points (post-op: 1 month, time 1: 3 months, time 2: 1 year) for the two treatment groups. (Right panel): Time-to-adverse event for the two treatments.
Figure 3
Figure 3
(Left panel): LDL measurements at different time points for the patients treated with standard treatment (grey lines) and “new” Evolocumab treatments (blue lines). The bold line are the regression line estimates. (Right panel): total cholesterol measurements at different time.
See this image and copyright information in PMC

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