| Purpose:1.To investigate the effect of early postoperative application of Envolocumab on blood lipid levels in patients with ultra-high risk ASCVD after PCI.2.According to the ESC/EAS guidelines and the domestic expert consensus on the requirements of LDL-C target value,the blood lipid attainment rate of patients in the treatment group and the control group was compared during follow-up.3.The incidence of MACE between the two groups was compared to evaluate whether early use of Envolocumab could reduce cardiovascular risk in patients with ultra-high risk ASCVD.Method:This study prospectively included 203 patients who were diagnosed with ultra-high risk ASCVD after PCI in the Emergency Department of Affiliated Hospital of Qingdao University from January 2021 to January 2022.Patients who received Envolocumab within 7days after PCI were included in the treatment group(102 cases),and patients who did not receive Envolocumab after PCI were included in the control group(101 cases).Basic admission data including age,gender,smoking history,drinking history,BMI,hypertension history,diabetes history,clinical diagnosis and stent implantation in interventional operation were collected,and frequency score(Gensini score)of the severity of vascular stenosis was calculated according to the patients’ vascular lesions.Follow-up(including telephone follow-up,readmission follow-up and outpatient follow-up)was conducted at 1 month,3months and 6 months after discharge of patients in the two groups.Follow-up indicators of patients in the two groups included: Total cholesterol(TC),triglycerides(TG),low density lipoprotein cholesterol(LDL-C),Apolipoprotein B(Apo B),high density lipoprotein cholesterol(HDL-C),lipoprotein(a),uric acid,alanine aminotransferase(ALT),aspartate aminotransferase(AST),left ventricular ejection fraction(LVEF).Meanwhile,the recurrence rate and occurrence time of cardiovascular adverse events(including all-cause death,myocardial infarction and angina attack)after discharge were compared between the two groups.Results:1.The basic admission data of the two groups were as follows: gender,age,BMI,clinical diagnosis,history of hypertension,diabetes,drinking history,smoking history,blood glucose,glycated hemoglobin,transaminase(AST,ALT),uric acid,low density lipoprotein cholesterol(LDL-C),total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(H DL-C),lipoprotein a(LP(a)),Apolipoprotein B(Apo B),left ventricular ejection fraction(LVEF),numbers of stents implanted and Gensini score showed no statistical significance(p > 0.05),indicating that the two groups were comparable.2.There were no significant differences in HDL-C,TG,AST,ALT,Uric acid and LVEF between 2 groups at 1 month,3 months and 6 months of follow-up after discharge(p > 0.05).TC,LDL-C and Apo B in the treatment group were significantly lower than those in the control group,with statistical significance(p < 0.01),LP(a)in the treatment group was also significantly lower than that in the control group,with statistical significance(p < 0.05).Compared with the control group,the rate of LDL-C reaching the standard was significantly higher in the treatment group,89.21% of patients with LDL-C < 1.4mmol/L in the treatment group and only 47.52% in the control group one month after leaving the hospital,while60.40% of patients with LDL-C < 1mmol/L in the treatment group were found to have reached the standard in the 1-month follow-up.The control group was only 10.89%,the difference was statistically significant(p < 0.01).3.The incidence of MACE(all-cause death,myocardial infarction,angina attack)in the treatment group was significantly decreased(10.78%vs21.78%),and the difference was statistically significant(p = 0.034).Conclusion:Early use of Envolocumab can significantly reduce blood lipids(TC,TG,LDL-C,Apo B,Lp(a)),significantly improve the LDL-C compliance rate of ultra-high-risk ASCVD patients after PCI,and reduce the risk of adverse events. |
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