Clinical Effect of Evolocumab treatment in coronary artery bypass surgery
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Background
We demonstrated that Evolocumab treatment after coronary artery bypass graft surgery significantly reduced LDL-cholesterol and total cholesterol levels compared to statin treatment alone. However, in the short period following surgery, did not impact the reduction of major clinical events.
Methods
We collected dyslipidemic patients who underwent coronary artery bypass graft surgery following acute coronary syndrome or in an elective setting (254 patients). Since January 2020, we added to statin therapy with or without ezetimibe also an immediate postprocedural treatment with subcutaneous evolocumab, either 140 mg every 2 weeks; the previous period patients underwent a conventional treatment with statins. All patients were followed up clinically and laboratory, comparing the 2 groups (Standard vs Evolocumab).
Results
The variables were inserted into a Cox model, which found a significant impact for Group, Hypertension, EUROSCORE_II and previous stroke. In detail, the treatment with Evolocumab had a protective effect on the clinical events (recurrent angina, myocardial infarction, cerebrovascular events, need for coronary re-angiography, coronary artery re-angioplasty/re-bypass and cardiac death), with a HR of 0.38 (95% CI 0.15-0.99, p=0.047). Furthermore, cholesterol levels decreased more quickly over time in the evolocumab-treated group than in the conventional group, with an average difference of 27 mg/dl (p<0.01). Similarly, LDL decreased by approximately 30 mg/dl (p<0.001), triglycerides by approximately 18.77 mg/dl (p<0.001), while HDL increased by an average of 2.7 mg/dl more than in the conventional therapy (p<0.001).
Conclusion
The use of Evolocumab immediately after coronary artery bypass graft surgery, even in an urgent or elective setting, significantly reduced cholesterol levels compared to statin treatment alone. Moreover, this strategy in statin-resistant patients is also able to significantly reduce the major clinical cardiac events at follow-up.
