Phase 4
N=137
Effect of Evolocumab on Coronary Plaque Characteristics
Coronary Artery Disease
Bottom Line
View on ClinicalTrials.gov: NCT04710368 ↗Enrolled (actual)
137
Serious AEs
4.6%
Results posted
May 2023
Primary outcome: Primary: Change in Minimal Fibrous Cap Thickness (FCT) — 70.9; 97.7 µm
Study Design & Population
- Study type
- Interventional
- Phase
- Phase 4
- Interventions
- Evolocumab Injections (Drug)
- Age
- Adult, Older Adult · 18+ yrs
- Sex
- All
- Sponsor
- Annapoorna Kini
- Primary completion
- Oct 2022
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Change in Minimal Fibrous Cap Thickness (FCT) |
70.9; 97.7 | — |
| PRIMARY Number of Participants With FCT <65 µm |
53; 14 | — |
| PRIMARY Number of Participants With Increased Fibrous Cap |
88 | — |
| PRIMARY Change in maxNIRS4mm |
306.8; 213.1 | — |
| PRIMARY Number of Participants With Decreased maxLCBI4mm |
86 | — |
| SECONDARY Change in Maximal Lipid Arc |
189.1; 161.6 | — |
| SECONDARY Change in Lipid Length |
10.4; 8.9 | — |
| SECONDARY Change in Lipid Volume Index (LVI) |
1259.4; 972.0 | — |
| SECONDARY Change in Macrophage Accumulation |
148.2; 122.1; 83.4; 71.2 | — |
| SECONDARY Change in Macrophage Volume Index |
876.4; 590.0 | — |
| SECONDARY Change in Macrophage Length |
9.6; 7.6 | — |
| SECONDARY Change in Calcification Accumulation |
98.6; 98.6; 61.1; 61.2 | — |
| SECONDARY Change in Calcium Length |
6.4; 6.7 | — |
| SECONDARY Change in Percent Atheroma Volume (PAV) |
51.6; 50.2 | — |
| SECONDARY Change in Total Atheroma Volume (TAV) |
137.2; 131.2 | — |
| SECONDARY Change in PBMC Gene Expression |
— | — |
Summary
The aim of the study is to assess the effect of evolocumab on coronary plaque morphology using intravascular imaging and gene expression analysis of peripheral blood mononuclear cells (PBMC) in patients with stable CAD on maximally tolerated statin therapy. The study combines multi-modality intravascular imaging approaches and transcriptomic based machine learning algorithms to uncover molecular mechanisms responsible for the beneficial changes in atherosclerotic lesions of patients treated with evolocumab. The primary end-points are the changes from baseline to follow-up in (1) the minimal fibrous cap thickness (FCT) assessed by optical coherence tomography (OCT) and (2) maxLCBI4mm assessed by near-infrared spectroscopy (NIRS) after 26 weeks of evolocumab. The secondary endpoints are the changes in (1) the maximal lipid arc, lipid length, lipid volume index, macrophage accumulation and calcification by OCT; (2) PAV and TAV defined by intravascular ultrasound (IVUS) and (3) Changes in PBMC gene expression.
Eligibility Criteria
Inclusion criteria
- Men or women aged 18 years or older at screening who signed written Informed Consent
- Patients with coronary artery disease undergoing cardiac catheterization and PCI for a target lesion and also have a non-obstructive lesion (30-50% stenosis) identified by angiography
- Patients who are not candidates for PCI or CABG currently or over the next 12 months, in the opinion of the investigator
- Patients treated with statins for at least 4 weeks with LDL-C level ≥ 80 mg/dL for low- or moderate -intensity statin use and ≥ 60 mg/dL for high-dose statin. Patients with history of statin intolerance and LDL-C ≥ 100 mg/dL.
- Angiographic criteria: 30-50% reduction of lumen diameter in addition to the target lesion accessible by the OCT catheter. The target segment should not have a history of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), and may not be a bypass graft.
- OCT criteria: target segment should have a lipid-rich plaque with lipid arc >90° and fibrous cap thickness ≤120 µm.
- Women of childbearing potential must agree to be on an acceptable method of birth control/contraceptive
Exclusion criteria
- Patients who have acute myocardial infarction (Q wave or non-Q wave with CK-MB > 5 times above the upper normal (31.5 ng/ml) within 72 hours)
- Patients who are in cardiogenic shock
- Patients with left main disease, in-stent restenotic lesions or patients requiring coronary artery bypass graft surgery
- Patients with elevated CK-MB (>6.3 ng/ml) or Tnl (>0.5 ng/ml)
- Patients with platelet count 2.0 mg/dL
- Pregnant women and women of childbearing potential who intend to have children during the duration of the trial
- Patients having undergone heart transplantation, or those that may undergo heart transplantation during the study period
- Patients with active autoimmune disease
Data sourced from ClinicalTrials.gov (NCT04710368). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.