Coronary disease & ACSRandomised controlled trial
LDL Cholesterol Lowering With Evolocumab Before Percutaneous Coronary Intervention for Acute Myocardial Infarction
- Randomised controlled trial
- phase 4
- open
- blinded end-point adjudication
- international
- 48 sites in 6 countries
Authors' conclusion
In patients with acute MI undergoing PCI, first-line evolocumab combined with high-intensity lipid-lowering therapy produced rapid and sustained LDL-C reduction, with more than 80% of patients reaching the guideline-recommended target at 1 year. However, no clinical benefit was detected during the first year of follow-up, arguing against clinically meaningful acute pleiotropic effects of PCSK9 inhibitors in addition to standard care.
Study context
- Population
- Adults with high-risk ST-elevation MI (STEMI) (aged >55 years) or non-ST-elevation MI (NSTEMI) with ≥1 additional high-risk characteristic undergoing percutaneous coronary intervention (PCI)
- Participants
- 2,161 adults
- Comparison
- Evolocumab vs Standard care
- Evolocumabn = 1,087
- Standard caren = 1,074reference
- Primary endpoint
- Low-density lipoprotein cholesterol (LDL-C) <55 mg/dL and ≥50% reduction in LDL-C from baseline
- Follow-up
- 12 months
Primary result
As reported in the abstract
Adjusted odds ratio
5.54
95% CI 4.50–6.82
P < 0.001
Events by treatment group
Evolocumab vs Standard care
adjusted OR 5.54 (95% CI 4.50–6.82); P < 0.001
Further findings
Median LDL-C · 6 weeks
| Outcome | Evolocumab | Standard care | adjusted OR (95% CI) | P value | |
|---|---|---|---|---|---|
| Main clinical end point: all-cause death or unplanned CV hospitalization · 12 months | 14.6% | 15.4% | 0.94 (0.73–1.19) | P = 0.59 | |
| 0.512Adjusted odds ratio (log scale) |
Original publication
LDL Cholesterol Lowering With Evolocumab Before Percutaneous Coronary Intervention for Acute Myocardial Infarction. JAMA. Published 29 August 2026. doi:10.1001/jama.2026.17302
Summarised from the published abstract; every number is checked against it