Preoperative Intensive Lipid-Lowering with evolocumab plus rosuvastatin Improves Secondary Outcomes After STEMI: Study

A new study published in the journal of PloS One showed that although reoperative therapy with evolocumab with rosuvastatin improved a number of clinically relevant secondary outcomes, it did not significantly lower 6-month major adverse cardiovascular events (MACEs).

Acute ST-segment elevation myocardial infarction (STEMI), is the result of the rupture of weak atherosclerotic plaques, which results in coronary blockage and myocardial necrosis. Even while prompt reperfusion treatment has increased survival, results are still impacted by lingering hazards such inflammation, microvascular dysfunction, and ischemia-reperfusion damage.

Cardiovascular risk rises linearly with low-density lipoprotein cholesterol (LDL-C), which is a key factor in atherogenesis. First-line treatment consists of statins, and PCSK9 inhibitors are given as needed. The pleiotropic and lipid-lowering actions of evolocumab and rosuvastatin are complimentary. The benefits of single-dose preoperative usage are still unknown, however long-term combination treatment lowers events. The effectiveness and safety of single-dose evolocumab plus medium-dose rosuvastatin prior to PCI in patients with STEMI are assessed in this trial.

80 STEMI patients receiving emergency PCI were randomized in this study at Liaocheng People's Hospital (2023–2024) to 2 groups. The treatment group where prior to PCI, a single subcutaneous evolocumab 140 mg with oral rosuvastatin 10 mg was given, followed by rosuvastatin 10 mg daily and control group where after PCI, rosuvastatin 10 mg daily was started on its own. MACEs at 6 months were the main outcome. Angina incidence, interleukins, low-density LDL-C levels, and ST-segment resolution rate (STR) were secondary objectives.

At the 6-month follow-up, the incidence of MACEs, the primary endpoint, was 5.0% in the treatment group when compared to 12.5% in the control group. Angina occurred significantly less frequently in the treatment group than in the control group. The treatment group also demonstrated significantly greater reductions in LDL-cholesterol, evident as early as day 1 (2.97 ± 0.63 vs. 3.33 ± 0.78 mmol/L, P = 0.029), day 7 (1.66 ± 0.89 vs. 2.25 ± 0.77 mmol/L, P = 0.003), and persisting at 1 month (P = 0.036).

Also, ST-segment resolution exceeding 70% was observed more frequently in the treatment group when compared to controls. Circulating inflammatory markers were also significantly lower in the treatment group, including interleukin-6 (P = 0.02) and interleukin-17 (P = 0.01), indicating an attenuated inflammatory response.

Overall, the evolocumab-rosuvastatin combination showed clinically significant benefits (decreased angina frequency, accelerated LDL-C lowering, improved myocardial reperfusion, and attenuated inflammatory response) with a favorable safety profile, even though it did not significantly reduce 6-month MACEs.

Source:

Li, H., Dong, H., Bao, S., Wang, X., & Fu, Z. (2026). The efficacy of preoperative evolocumab-rosuvastatin combination therapy in patients with ST-elevation myocardial infarction. PloS One, 21(1), e0339501. https://doi.org/10.1371/journal.pone.0339501