ArticleFrontiers in cardiovascular medicine2026
Ultra-early in-cath lab evolocumab achieves rapid lipid target attainment and lipid quality improvement in acute coronary syndrome: a real-world propensity score-matched study.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Current guidelines mandate stringent low-density lipoprotein cholesterol (LDL-C) control for patients with acute coronary syndrome (ACS). However, real-world evidence regarding the ultra-early, in-cath lab initiation of PCSK9 inhibitors and their impact on lipid quality-specifically the clearance of highly atherogenic small dense LDL (sdLDL)-remains scarce. This study aimed to evaluate the short-term efficacy and safety of this ultra-early evolocumab intervention strategy. Methods: This real-world, prospective observational cohort study categorized ACS patients into three treatment groups: statin monotherapy, statin plus ezetimibe, and statin plus evolocumab. Evolocumab was administered ultra-early in the catheterization laboratory immediately after angiographic confirmation. A rigorous propensity score matching (PSM) was conducted to balance baseline characteristics. Primary endpoints included the 4-week LDL-C target achievement rate (<1.4 mmol/L and ≥50% reduction). Secondary endpoints focused on sdLDL clearance and safety outcomes. Results: From an initial screening pool of 665 patients, a rigorous PSM established a final core analysis cohort of 382 matched patients (127 in the statin monotherapy group, 127 in the ezetimibe group, and 128 in the evolocumab group). At 4 weeks, the evolocumab group demonstrated a substantially higher dual LDL-C target attainment rate compared to the ezetimibe group (66.4% vs. 33.1%, Statin + Evolocumab vs. Statin + Ezetimibe; Conclusions: The ultra-early, in-cath lab initiation of evolocumab in ACS patients drives rapid, large-scale LDL-C target attainment and demonstrates an absolute advantage in the marked reduction of highly atherogenic sdLDL particles. This deep reversal of the lipid burden provides robust real-world evidence supporting the forward-shifting of intensive lipid-lowering interventions in the acute phase of ACS. Trial Registration: Chinese Clinical Trial Registry, ChiCTR2600118799.
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