The Clinical Study Of Evolocumab In Improving Lipid Metabolism And Carotid Atherosclerosis In ACS Patients With PCI

BackgroundAtherosclerosis(AS)is one of the most serious illnesses affecting human health.At present,statins remain the cornerstone of anti-atherosclerosis treatment both at home and abroad.Although most patients continue to have satisfactory clinical outcomes when treated with standard statin dosages,for some patients who cannot attain the target or tolerate high-dose statin therapy,a single application of statin medicines cannot meet the therapeutic purpose.New lipid-lowering drugs,PCSK9 inhibitors,can further reduce LDL on top of statins,while playing an important role in delaying the progression of arteriosclerosis and reducing the rate of rehospitalization for coronary artery disease and adverse cardiovascular events.ObjectiveThe purpose of this study was to compare the efficacy of carotid atherosclerotic plaque treatment,lipid changes,the incidence of cardiovascular adverse events,and the safety of the combination in patients undergoing PCI for acute coronary syndrome(ACS)with the PCSK9 inhibitor evolocumab(trade name:Rui Bai An)in combination with atorvastatin to atorvastatin alone.MethodFrom January 2020 to April 2021,207 patients diagnosed with acute coronary syndrome and undergoing coronary stenting(PCI)were hospitalized in the Department of Cardiovascular Medicine of Huaihe Hospital of Henan University and had carotid vascular plaque formation confirmed by carotid color Doppler ultrasonography.The patients were randomly divided into experimental group(103)and control group(104).The experimental group was treated with subcutaneous injection of evolocumab combined with oral atorvastatin,and the control group was treated with oral atorvastatin alone.The changes of blood lipids and carotid plaques in the two groups were observed at the corresponding time points of treatment,and the cardiovascular adverse events and adverse drug reactions in the two groups were compared.Result1.There was no statistical difference between the clinical data of patients in the experimental group and the control group at the time of enrollment(P>0.05).2.The serum TC,TG,HDL and Lp(a)levels at baseline were not statistically different between the two groups(P>0.05),and the serum TG,TC and Lp(a)levels in both groups decreased compared with baseline at each time point of treatment,and the decrease was more obvious in the experimental group,which was statistically different(P<0.05).3.There was no statistical difference in serum LDL-C levels between the two groups at baseline(P>0.05),and at 1 week,3 months,6 months and 10 months of treatment,serum LDL-C levels decreased more significantly in the experimental group than in the control group at each time point,and the difference was statistically significant(P<0.05).The LDL-C compliance rate(compliance: LDL-C <1.4 mmol/L)was67.3% in the experimental group and 19% in the control group at 10 months of treatment,with the statistical difference(P<0.05).4.The c IMT and carotid plaque Crouse scores of patients in both groups before treatment were not statistically different(P>0.05).After 10 months of treatment,the c IMT and carotid plaque Crouse scores of patients in both groups decreased compared with those before treatment,and the changes in c IMT and carotid plaque Crouse scores in the experimental group were more obvious compared with those in the control group,which were statistically different(P<0.05).5.The readmission rate of angina pectoris and the total incidence of adverse cardiovascular and cerebrovascular events in the experimental group were lower than those in the control group after 10 months of treatment in both groups,with statistical differences(P<0.05).There was no statistical difference between the two groups in the incidence of adverse events of coronary death,stroke,acute myocardial infarction,and coronary revascularization(P>0.05).6.There was no statistical difference in the incidence of liver function abnormalities(transaminase elevation ≥ 3 times the upper limit of the reference value),neurocognitive events,myalgia,new onset diabetes,and total adverse drug reactions between the two groups during treatment(P>0.05).Conclusion1.Evolocumab combined with atorvastatin can rapidly reduce serum LDL-C levels and improve serum LDL-C compliance in patients undergoing PCI for ACS,and also reduce serum TG,TC,and Lp(a)levels in patients at the same time.2.Evolocumab combined with atorvastatin improved carotid atherosclerosis and reduced the rate of angina pectoris readmission and total cardiovascular events in patients undergoing PCI for ACS.3.The safety of evolocumab combined with atorvastatin was good and did not increase the incidence of adverse drug reactions.