Clinical effect of proprotein convertase subtilisin/kexin type 9 inhibition in patients undergoing coronary artery bypass surgery

Objectives To evaluate whether adding evolocumab to statin plus ezetimibe in patients undergoing coronary artery bypass grafting improves lipid control and reduces clinical events. Methods This retrospective study included 254 patients with dyslipidemia undergoing coronary artery bypass grafting. Of these, 111 received statin + ezetimibe plus evolocumab, whereas 143 received only statin + ezetimibe. The 2 groups were compared for lipid levels and cardiovascular outcomes. Cox regression analysis identified significant predictors of events, including treatment group, hypertension, European System for Cardiac Operative Risk Evaluation II, and previous stroke. Results Mean follow-up was 70 ± 20 months in the evolocumab group and 48 ± 18 months in the control group, with a minimum follow-up of 24 months for all enrolled patients. Evolocumab treatment showed a protective effect on composite hard major cardiovascular events (primary end point): cardiovascular death, myocardial infarction, cerebrovascular events, and repeat coronary revascularization (percutaneous coronary intervention/coronary artery bypass grafting) with a hazard ratio of 0.29 (95% CI, 0.10-0.86, P = .026) in the time-to-first-event analysis administratively censored at 24 months. Recurrent angina, a secondary end point, did not significantly differ between groups. Cholesterol levels decreased more rapidly in the evolocumab group, with a mean total cholesterol reduction of 27 mg/dL ( P < .01), low-density lipoprotein by 30 mg/dL ( P < .001), triglycerides by 18.77 mg/dL ( P < .001), and a high-density lipoprotein increase of 2.7 mg/dL ( P < .001), compared to the control group. Conclusions Evolocumab added early to standard therapy after coronary artery bypass grafting achieved greater lipid lowering and was associated with fewer hard cardiovascular events during midterm follow-up.