Effect of Very Early and Rapid Lowering Cholesterol With Evolocumab on Left Ventricular Remodeling in Patients With Anterior STEMI Undergoing Primary PCI

NCT ID: NCT05613426

Last Updated: 2024-12-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE4

Total Enrollment

330 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-04-03

Study Completion Date

2026-12-30

Brief Summary

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For patients with anterior ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), whether early application of proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors to rapidly reduce low-density lipoprotein cholesterol (LDL-C) before PCI could effectively inhibit left ventricular remodeling has been rarely reported. The aim of this study was to investigate the effect of early application of PCSK9 inhibitors Evolocumab to rapidly reduce LDL-C levels before primary PCI treatment on left ventricular remodeling in STEMI patients.

Eligible patients were randomly randomized 1:1:1 to one of the following three groups immediately after enrollment: (1) Intensive statin group: rosuvastatin 20 mg per day, in addition to usual therapy; (2) Combined intensive statin and PCSK9 inhibitor group: rosuvastatin 20 mg per day and subcutaneous injection of evolocumab 140 mg twice a month, for at least 3 months, and preferably 6 months; (3) PCSK9 inhibitor alone group: subcutaneous injection of evolocumab 140 mg, twice a month for at least 3 months and preferably 6 months.

Detailed Description

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Conditions

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ST Elevation Myocardial Infarction (STEMI)

Keywords

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ST Elevation Myocardial Infarction percutaneous coronary intervention PCSK9 Inhibitors left ventricular remodeling

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Intensive statin group

Rosuvastatin, 20 mg per day after randomization

Group Type ACTIVE_COMPARATOR

Rosuvastatin 20 mg

Intervention Type DRUG

Very early use of Rosuvastatin before primary PCI in anterior STEMI

Combined intensive statin and PCSK9 inhibitor group

Evolocumab, 140 mg twice a month after randomization, and Rosuvastatin, 20 mg per day after randomization

Group Type EXPERIMENTAL

Rosuvastatin 20 mg

Intervention Type DRUG

Very early use of Rosuvastatin before primary PCI in anterior STEMI

Evolocumab 140 mg/1 ml Subcutaneous Solution [REPATHA]

Intervention Type DRUG

Very early use of Evolocumab before primary PCI in anterior STEMI

PCSK9 inhibitor alone group

Evolocumab, 140 mg twice a month after randomization

Group Type EXPERIMENTAL

Evolocumab 140 mg/1 ml Subcutaneous Solution [REPATHA]

Intervention Type DRUG

Very early use of Evolocumab before primary PCI in anterior STEMI

Interventions

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Rosuvastatin 20 mg

Very early use of Rosuvastatin before primary PCI in anterior STEMI

Intervention Type DRUG

Evolocumab 140 mg/1 ml Subcutaneous Solution [REPATHA]

Very early use of Evolocumab before primary PCI in anterior STEMI

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Age 18-75 years
* Persistent chest pain or chest discomfort
* Onset within 12 hours
* ST-segment elevation ≥0.1 millivolt in two adjacent precordial leads, or a new-onset left bundle branch block with dynamic changes
* Primary PCI is planned

Exclusion Criteria

* Contraindications to Statins or PCSK9 inhibitors
* Prior intravenous thrombolytic therapy
* Prior use of Statins, PCSK9 inhibitors or Ezetimibe
* Cardiogenic shock
* Acute heart failure or pulmonary edema
* Prior chronic heart failure
* Severe hepatic and renal insufficiency (alanine aminotransferase ≥5 upper limit of normal; estimated glomerular filtration rate \<30ml/min/1.73m2, or on dialysis)
* Prolonged (\> 20 minutes) cardiopulmonary resuscitation
* Definite mechanical complications (including ventricular septal perforation, or rupture of the Papillary tendon bundle, or rupture of the left ventricular free wall)
* Malignant arrhythmias that are difficult to control with drugs
* Severe chronic obstructive pulmonary disease or respiratory failure
* Severe infection
* Neurological disorders
* Bleeding history of cerebrovascular, gastrointestinal, respiratory, urinary or other organs within the last month
* Active bleeding or bleeding diatheses
* Use of anticoagulants
* Malignant tumors or other pathophysiological conditions with an expected survival time of less than 1 year
* Pregnant or lactating women
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Henan Institute of Cardiovascular Epidemiology

OTHER

Sponsor Role lead

Responsible Party

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Chuanyu Gao

Vice President, Chief of Cardiology Department

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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The People's Hospital of Gongyi

Gongyi, Henan, China

Site Status RECRUITING

Kaifeng Central Hospital

Kaifeng, Henan, China

Site Status RECRUITING

The People's Hospital of Changyuan

Xinxiang, Henan, China

Site Status RECRUITING

Hopeshine Minsheng Hospital of Xinzheng

Xinzheng, Henan, China

Site Status RECRUITING

The People's Hospital of Xuchang

Xuchang, Henan, China

Site Status RECRUITING

Fuwai Central China Cardiovascular Hospital

Zhengzhou, Henan, China

Site Status NOT_YET_RECRUITING

Countries

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China

Central Contacts

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You Zhang, Doctor

Role: CONTACT

Phone: +86 37158681037

Email: [email protected]

Facility Contacts

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Lei Li

Role: primary

Jieyun Liu

Role: primary

Guangyan He

Role: primary

Yanhong Li

Role: primary

Shuya Zhou

Role: primary

Junhui Zhang, Doctor

Role: primary

Other Identifiers

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HenanICE202204

Identifier Type: -

Identifier Source: org_study_id