Physicians' Academy for Cardiovascular Education

PCSK9i reduces MACE and coronary revascularization in patients with prior PCI

Effect of Evolocumab in Patients With Prior Percutaneous Coronary Intervention

Literature - Furtado RHM, Fagundes AA Jr, Oyama K et al., - Circ Cardiovasc Interv 2022, 10.1161/CIRCINTERVENTIONS.121.011382

Introduction and methods


There is a need to improve outcomes for patients who have undergone percutaneous coronary intervention (PCI), because these patients remain at high risk of subsequent myocardial infarction (MI) and coronary revascularization [1-3].

The PCSK9 inhibitor evolocumab reduced major adverse events (MACE) by 15% compared to placebo in patients with clinically overt stable ASCVD and additional high-risk features in the FOURIER trial [4].

In this prespecified analysis was investigated whether patients with prior PCI identified a subset of patients who in particular benefitted from PCSK9 inhibition, whether effects of evolocumab were similar across a range of procedures types and whether these findings varied based on time from most recent PCI.


Patients in the FOURIER trial had established, but stable ASCVD and had to have baseline LDL-c ≥70 mg/dL or non-HDL-c ≥100 mg/dL on stable treatment with statin, with or without ezetimibe. Patients were also required to have at least one additional high-risk criterion. Median follow-up in FOURIER was 2.2 years.

17,073 Patients (61.9%) in the FOURIER trial had a documented history of prior PCI at baseline and 10,455 (37.9%) had not.


Primary endpoint was time to MACE, a composite of CV death, MI, stroke, unstable angina or coronary revascularization.

Main results


This prespecified subgroup analysis of FOURIER showed that risk reduction for MACE with evolocumab was similar in patients with and without prior PCI. Moreover, in patients with prior PCI, evolocumab treatment resulted in risk reduction of coronary revascularization which extended to a broad range of lesion types.


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Find this article online at Circ Cardiovasc Interv

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