ACC 23: Effect of Evolocumab on Coronary Plaque Morphology: The YELLOW III Study

Principle investigator of YELLOW III, Dr Annapoorna Subhash Kini (Mount Sinai Hospital, US) joins us to talk about the study that assessed the effect of evolocumab (Repatha) on coronary plaque morphology using intravascular imaging and gene expression analysis of peripheral blood mononuclear cells (PBMC) in 140 patients with stable CAD on maximally tolerated statin therapy.
The study showed that more intensive lipid lowering
with addition of evolocumab for 26 weeks resulted in significant and substantial increase
in the minimum FCT by OCT, reduction in NIRS maxLCBI4mm and reduction in atheroma
volume by IVUS in angiographically non-obstructive lesions.
Questions:
1. What prompted the YELLOW studies?
2. What are the baseline characteristics of the enrolled patients?
3. What are the key findings presented at ACC?
4. What are the potential implications for patient care?
For more content from ACC.23/WCC head to the Late-Breaking Science Video Collection.
Recorded on-site at ACC.23, New Orleans.
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[@georgecav]

So why weren’t these followed a lot longer to see if this actually would have a benefit on primary endpoints on mi death or stroke? At the end of the day, that’s all that really matters to patients although better flow would seem desirable.

[@advancedcardiolresearchphy2086]

Very interesting conservative non invasive coronary revascularization trial for patients presented with non ACS coronary atherosclerotic diseases using rusovastatin 40mg for 6-8wks. Unknown primary endpoints. Secondary endpoints were reduction in intermediate biomarkers such as inflammatory CRP, cholesterol level with intension to imaging reduction of plaque size. Subgroup analyses with effect modifiers is missing. Side effect of using the drug in those patients with polypharmacy and comorbidity justifying its use for such intervention is lacking.
I would rather recommend cross over to better therapeutic strategy.
Marwah Zahaf MD Msc