Abstract

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.

Competing Interest Statement

The authors have declared no competing interest.

Clinical Trial

The study isn't registered

Funding Statement

None

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

"COMITATO ETICO TERRITORIALE" Bari approved the study with two different protocols for elective (Prot. N. 001.06.96. Study number 7815) and "acute coronary syndrome" patients (Prot. N. 22.01.24. Study number 7809)

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Yes

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Yes

Data Availability

The data used and analyzed in this study are available upon reasonable request from the corresponding author. The analysis was conducted in accordance with the transparency and openness (TOP) guidelines of AHA journals. All methodological details, including patient selection criteria, treatment procedures, and statistical analyses, are described in the manuscript. Any additional data or supplementary materials can be provided upon request, in compliance with ethical regulations and patient privacy policies.

Non-standard Abbreviations and AcronymsACSAcute Coronary SyndromeCABGCoronary Artery Bypass GraftingCPKCreatine PhosphokinaseEUROSCORE IIEuropean System for Cardiac Operative Risk Evaluation IIIMAAcute Myocardial InfarctionLDL-CLow-Density Lipoprotein CholesterolNSTE-ACSNon-ST-Segment Elevation Acute Coronary SyndromePCSK9Proprotein Convertase Subtilisin/Kexin Type 9PCSK9iPCSK9 InhibitorSTEMIST-Elevation Myocardial InfarctionSTE-ACSST-Segment Elevation Acute Coronary Syndrome