Effect Of PCSK9 Inhibitor Evolocumab On The Degree Of Coronary Artery Stenosis In Patients With Coronary Heart Disease

Objective:To investigate the effect of PCSK9 inhibitor Evolocumab on the degree of coronary artery stenosis in patients with coronary heart disease.Methods:A retrospective study was performed to screen patients with coronary heart disease hospitalized in the Heart Center of Henan Provincial People’s Hospital(Central China Fuwai Cardiovascular Hospital)during 2019.04.01-2021.12.31 a total of 116 patients were included according to the inclusion and exclusion criteria,and patients were divided into two groups according to whether Evolocumab injection was used,58 patients in the test group were given oral atorvastatin calcium tablets(20mg once per night)or rosuvastatin calcium tablets(10mg once per night)and subcutaneous Evolocumab injection(420mg once a month or 140mg once every two weeks);In the control group,58 patients were treated with atorvastatin calcium tablets(20 mg once per night)or rosuvastatin calcium tablets(10 mg once per night)orally,and both patients were treated according to the above drugs and dosage continuously for 1 year.Age,gender,body mass index(BMI),history of hypertension,diabetes mellitus,smoking,medication use(antiplatelet medicationβReceptor blockers,ACEI/ARB drugs,CCB drugs),white blood cell count,neutrophil count,hemoglobin,mean corpuscular volume,platelets,creatinine,urea,uric acid,creatine kinase,liver biochemistry(Alanine aminotransferase,Aspartate aminotransferase),total cholesterol(TC),triglycerides(TG),high-density lipoprotein(HDL-C)Low density lipoprotein cholesterol(LDL-C),apolipoprotein A1(apo A1),apolipoprotein B(apo B),left ventricular ejection fraction(LVEF%)were recorded for all included individuals,and statistical coronary angiography findings.The degree of coronary artery stenosis of the patients were assessed using two coronary evaluation methods:Gensini and ACC/AHA.Coronary angiography,blood lipids,renal function,liver function,creatine kinase,etc.were reviewed 1 year later,Comparing the degree of coronary stenosis and changes in biochemical parameters before and after the test between the test group and the control group.And multiple linear regression was used to analyze whether the use of evolocumab injection was a factor affecting the degree of coronary stenosis.Statistical analysis the effect of using evolocumab injection on the lipid attainment and the incidence of major adverse cardiovascular events in patients.All data were analyzed using SPSS23.0 software,and differences were considered statistically significant when p<0.05.Results:1.There were no significant differences between the test and control groups in general data,baseline indexes,and the degree of coronary stenosis(P>0.05).2.In terms of the degree of coronary stenosis,Two methods were used to evaluate the degree of coronary artery stenosis.comparison within groups,the degree of coronary stenosis was reduced in both groups compared with before,in the test group,Gensini score before 1 year vs after 1 year:43.5(30.0,61.3)VS 25.0(15.8,37.3),differences were considered statistically significant(P<0.05);ACC/AHA score before 1 year vs after 1 year:8.0(5.0,10.3)VS 6.0(3.0,7.3),differences were considered statistically significant(P<0.05);in the control group,Gensini score before 1 year vs after 1 year:40.5(29.3,52.0)VS 39.0(28.8,45.3),differences were considered statistically significant(P<0.05);ACC/AHA score before 1 year vs after 1 year:8.0(6.0,10.0)VS 8.0(5.0,9.0),differences were considered statistically significant(P<0.05).Between groups,after 1 year,the reduction in stenosis was more pronounced in the test group than in the control group,Gensini score test group vs control group:25.0(15.8,37.3)VS39.0(28.8,45.3),differences were considered statistically significant(P<0.05),ACC/AHA score test group vs control group:6.0(3.0,7.3)VS 8.0(5.0,9.0),differences were considered statistically significant(P<0.05).3.Multivariate linear regression analysis was performed as follows:use of evolocumab was negatively associated with the difference in Gensini score(B=-14.974 95%CI:-18.575.-11.373R~2=0.373 P<0.001);use of evolocumab was negatively associated with the difference in ACC/AHA score(B=-2.052 95%CI:-2.643,-1.461 R~2=0.293 P<0.001),So the use of evolocumab injection might be a beneficial factor to alleviate the degree of coronary artery stenosis.4.In terms of lipid lowering,the percentage reduction in LDL-C was higher in the test group,and the lipid-lowering effect was more pronounced in the test group(test group VS control group:67.8%VS40.5%),differences were considered statistically significant(P<0.05),In terms of LDL-C compliance rates,test group compliance was higher(test groups VS control group:91.4%VS 25.9%),differences were considered statistically significant(P<0.05).The result of using logistics regression analysis showed that:the use of evolocumab injection was a beneficial factor to promote the lipid attainment.5.The rate of major adverse cardiovascular events was lower in the test group compared with the control group(test group VS control group:1.7%VS 5.2%),However,the difference was not statistically significant(P>0.05).6.After the test,no obvious adverse symptoms,such as myalgia and neurological dysfunction,liver and kidney function,creatine kinase(P>0.05),etc.,were observed in patients of both groups,and no obvious adverse effects were observed at the injection site of the test group.Conclusions:1.For patients with coronary heart disease,Evolocumab injection can further reduce the level of LDL-C and improve LDL-C compliance on the basis of moderate intensity statin treatment;2.Evolocumab injection may be a beneficial factor to reduce the degree of coronary artery stenosis in patients with coronary heart disease;3.Evolocumab injection can reduce the incidence of major adverse cardiovascular events in patients with coronary heart disease;4.Evolocumab injection is safe in the treatment of patients with coronary heart disease.