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The efficacy of preoperative evolocumab-rosuvastatin combination therapy in patients with ST-elevation myocardial infarctionHongxu Li1, Huawei Dong2, Shilin Bao2, Xuemei Wang2, Zuo-lin Fu2*1. Shandong First Medical University, Jinan, Shandong, China 2. Liaocheng Hospital Affiliated to Shandong First Medical University, Liaocheng, Shandong, China*[e-mail] impact of single-dose preoperative evolocumab combined with rosuvastatin therapy prior to emergency percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI) remains insufficiently characterized within current guideline-directed medical therapy. MethodsThe trial was registered at the Chinese Clinical Trial Registry (ChiCTR2500099498). In this prospective randomized trial conducted at Liaocheng People's Hospital (2023-2024), 80 STEMI patients undergoing emergency PCI were randomized to: Treatment group: Single subcutaneous evolocumab 140 mg plus oral rosuvastatin 10 mg administered pre-PCI, followed by rosuvastatin 10 mg/day; Control group: Rosuvastatin 10 mg/day alone initiated post-PCI.Primary endpoint was major adverse cardiovascular events (MACEs) at 6 months. Secondary endpoints included angina incidence, low-density lipoprotein cholesterol (LDL-C) levels, interleukins, and ST-segment resolution rate (STR). Results Primary endpoint (MACEs): 5.0% (treatment group) vs. 12.5% (control group) vs 12.5% (P=0.228) at 6-month follow-up.Secondary endpoints: Angina incidence: 7.5% vs 27.5% (P=0.037) at 6-month follow-up; LDL-C reduction: Significant in treatment group at day 1 (2.97±0.63 vs 3.33±0.78 mmol/L; P=0.029), day 7 (1.66±0.89 vs 2.25±0.77 mmol/L, P=0.003), and month 1 (P=0.036); ST-segment resolution >70%: 60% vs 30% (P<0.05) ; Inflammatory markers: Lower IL-6 (P=0.02) and IL-17 (P=0.01) in treatment group. ConclusionsWhile the evolocumab-rosuvastatin combination did not significantly reduce 6-month MACEs, it demonstrated clinically important benefits including reduced angina frequency, accelerated LDL-C lowering, improved myocardial reperfusion, and attenuated inflammatory response, with a favorable safety profile. These findings support further investigation of intensive lipid-lowering strategies in acute STEMI management.