Effect of Early Initiation of Evolocumab on Lipid Profiles Changes in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVES: Rapid reduction of low-density lipoprotein cholesterol (LDL-C) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) is critical but challenging. This study evaluated the efficacy and safety of early triple lipid-lowering therapy with evolocumab, a moderate-intensity statin, and ezetimibe in statin-naïve ACS patients. METHODS: The C-STAR trial (Effect of Early Initiation of Evolocumab on Lipid Profile Changes in Patients with ACS Undergoing PCI) was a single-center, randomized, open-label trial conducted from December 2022 to January 2025. A total of 108 statin-naïve ACS patients undergoing PCI were randomized to evolocumab (140 mg) plus rosuvastatin 5 mg and ezetimibe 10 mg (n=54) or rosuvastatin 5 mg and ezetimibe 10 mg alone (n=54). The primary endpoint was LDL-C level at 2 weeks; cognitive safety was assessed using the Everyday Cognition (ECog) tool. RESULTS: Baseline LDL-C levels were similar between the 2 groups. At 2 weeks, LDL-C levels were lower in the evolocumab group compared to the non-evolocumab group (31±16 mg/dL vs. 63±17 mg/dL; p