Effects of PCSK9 inhibitor evolocumab on preventing early neurological
deterioration in acute ischemic stroke patients with or without large artery
atherosclerosis: a subgroup analysis of a randomized trial
#MMPMID41107765
Liu J
; Li Y
; Tian W
; Cao H
; Li X
; Cheng L
; Ji X
; Liu J
BMC Neurol
2025[Oct]; 25
(1
): 431
PMID41107765
show ga
BACKGROUND: Our previous study has demonstrated the preventive effects of
proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor on early
neurological deterioration (END) in patients with acute non-cardiogenic ischemic
stroke. Here, we performed a post hoc subgroup analysis to investigate whether
the large artery atherosclerosis (LAA) subtype contributed to the clinical
outcomes. METHODS: According to the Trial of Org 10172 in Acute Stroke Treatment
(TOAST) classification, patients were divided into LAA and small vessel occlusion
(SVO) subgroups. In each subgroup, patients were further subdivided into
combination therapy of evolocumab and atorvastatin (PI group) and atorvastatin
monotherapy (AT group). The primary outcome was END within 7 days, defined as
a???2-point National Institutes of Health Stroke Scale (NIHSS) score increase or
NIHSS motor score???1-point compared with baseline. RESULTS: A total of 272
patients were included: 186 were categorized into the LAA subtype (93 in the PI
group and 93 in the AT group) and 86 into the SVO subtype (43 in the PI group and
43 in the AT group). Compared with AT group, the primary analyses showed a
significantly lower incidence of END with PI group in the LAA subtype (14.0%
versus 28.0%; RR, 0.45; 95% CI, 0.26 to 0.80; p?=?0.006), but not in the SVO
subtype (11.6% versus 16.3%; RR, 0.77; 95% CI, 0.26 to 2.33; p?=?0.649). Similar
results were observed in terms of favorable functional Outcome at 90 days,
combination therapy of evolocumab and atorvastatin was significantly associated
with a high proportion of modified Rankin Scale scores of 0-2 at 90 days in the
LAA group (81.7% versus 61.3%; RR, 1.39; 95% CI, 1.18 to 1.65; p?
|*Antibodies, Monoclonal, Humanized/therapeutic use
[MESH]
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