Abstract: Objective To investigate the lipid-lowering efficacy and safety of early evolocumab administration in ACS patients. Methods A total of 311 ACS patients (Jan-Dec 2023) receiving atorvastatin (20 mg QN) were randomized: observation group (Obs, n=213) started evolocumab within 48 h of hospital admission; control group (Ctrl, n=98) started post-PCI. Lipid profile (LDL-C, TC, TG, ApoB, HDL-C, ApoA-Ⅰ), LDL-C goal rate (＜1.4 mmol/L),the lipid ratios (TC/HDL-C, TG/HDL-C, LDL-C/HDL-C, ApoB/ApoA-Ⅰ), lipid variability (SD, CV, cVIM),cardiac function (LVEDD, LVESD, LVMI, LVEF), and liver/kidney function were assessed at discharge and 1, 3, 6 months. Results At 1 month, lipids decreased significantly vs baseline in both groups (P＜0.05). Obs showed greater reductions in LDL-C, TC, TG, ApoB vs Ctrl (P＜0.05). LDL-C goal rate increased over time, consistently higher in Obs (P＜0.05). Lipid ratios decreased more in Obs (P＜0.05). In both groups, LVEDD, LVESD, and LVMI decreased, while LVEF increased; the Obs group showed significantly greater improvements(P＜0.05) and milder liver/kidney impairment(P＜0.05).Liver/kidney impairment was less in Obs(P＜0.05). Conclusions Early evolocumab+ statin significantly lowers lipids, increases LDL-C goal attainment, reduces lipid variability, improves cardiac function/remodeling, and demonstrates better safety (less liver/kidney impairment) in ACS patients.

Key words: acaute coronary syndrome, evolocumab, lipid profile, left ventricular remodeling, lipid ratio