This presentation, delivered by Dr. Brian A. Bergmark and colleagues at EuroPCR 2026, detailed the results of the VESALIUS-CV trial, focusing specifically on the subgroup of patients with prior percutaneous coronary intervention (PCI) but without a history of myocardial infarction (MI) or stroke.
Patients with prior PCI but no previous MI are frequently encountered in clinical practice and remain at high risk for cardiovascular (CV) events. Despite this, rates of LDL cholesterol (LDL-C) monitoring and optimization are often suboptimal. The study aimed to evaluate the clinical benefit of intensive LDL-C lowering with evolocumab in this specific population.
A subgroup of 3,627 patients (from a total of 12,257 enrolled in the overall trial) with prior PCI was analyzed. Patients were randomized to receive evolocumab (140 mg every two weeks) or placebo. High-risk patients with atherosclerosis or diabetes and LDL-C ≥ 90 mg/dL despite optimized statin therapy were included. Follow-up duration was at least 4.5 years.
Treatment with evolocumab achieved a 61% reduction in LDL-C levels at 48 weeks, maintaining levels close to 1.0 mmol/L throughout the study.
In addition, a 30% relative risk reduction (HR 0.70; p=0.004) was observed in 3-point MACE (coronary death, MI, or ischemic stroke), along with a 18% reduction in 4-point MACE (including ischemia-driven revascularization).
Evolocumab also reduced the risk of myocardial infarction by 50% (HR 0.50; p<0.001), with significant reductions in both ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI). Furthermore, ischemia-driven revascularizations were reduced by 26%, while urgent revascularizations decreased by 39%.
Finally, nominal reductions were observed in cardiovascular death (34%) and all-cause mortality (24%). Regarding safety, evolocumab showed no significant differences compared with placebo.
Conclusions: Intensive LDL-C Lowering With Evolocumab May Benefit Even Patients Without Prior Myocardial Infarction
The presentation concluded that evolocumab significantly reduces the risk of major cardiovascular events in stable patients with prior PCI, even in the absence of previous myocardial infarction. These findings support intensive LDL-C lowering to levels close to 1 mmol/L in this high cardiovascular risk population.
Original Title: Evolocumab Results in Patients With Prior PCI: VESALIUS-CV Trial
Reference: Brian A. Bergmark et al EuroPCR 2026.
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