The Impact of Pcsk-9 Inhibition on PET CFR in Patients at High CV Risk

Description

The study protocol is a single-arm, open label pilot study designed to evaluate the impact of PCSK-9 inhibition on coronary blood flow in patients with stable coronary artery disease. Patients with stable coronary artery disease will be recruited from the BWH Cardiovascular Medicine clinic and/or from the BWH Nuclear Cardiology Laboratory. A target sample size of 50 participants will undergo imaging with N-13 ammonia or Rubidium-82 positron emission tomography (PET) and coronary computed tomography angiography (CCTA) before and after 12 months of PCSK-9 inhibition with Evolocumab to assess changes in myocardial blood flow, and plaque volume. To help account for physiological changes that may occur in myocardial blood flow and inflammatory biomarkers during the study period, we will also recruit a parallel control group of stable CAD patients who will undergo similar baseline and 12-month imaging and biomarker assessment. We plan to recruit 15 patients in the parallel control group.

Conditions

Stable Coronary Disease

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Study Overview

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Study Details

Study overview

The study protocol is a single-arm, open label pilot study designed to evaluate the impact of PCSK-9 inhibition on coronary blood flow in patients with stable coronary artery disease. Patients with stable coronary artery disease will be recruited from the BWH Cardiovascular Medicine clinic and/or from the BWH Nuclear Cardiology Laboratory. A target sample size of 50 participants will undergo imaging with N-13 ammonia or Rubidium-82 positron emission tomography (PET) and coronary computed tomography angiography (CCTA) before and after 12 months of PCSK-9 inhibition with Evolocumab to assess changes in myocardial blood flow, and plaque volume. To help account for physiological changes that may occur in myocardial blood flow and inflammatory biomarkers during the study period, we will also recruit a parallel control group of stable CAD patients who will undergo similar baseline and 12-month imaging and biomarker assessment. We plan to recruit 15 patients in the parallel control group.

The Impact of Pcsk-9 Inhibition on PET Coronary Flow Reserve in Patients at High Cardiovascular Risk (EMPOWER Study)

The Impact of Pcsk-9 Inhibition on PET CFR in Patients at High CV Risk

Condition
Stable Coronary Disease
Intervention / Treatment

-

Contacts and Locations

Boston

Brigham and Women's Hospital, Boston, Massachusetts, United States, 02115

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

For general information about clinical research, read Learn About Studies.

Eligibility Criteria

  • * Age: ≥ 50 (men) or ≥ 55 (women)
  • * Low-density lipoprotein cholesterol (LDL-C) ≥ 70 mg/dL
  • * Stable coronary artery disease (without plan to undergo revascularization before randomization) defined as one or more of the following:
  • 1. Abnormal nuclear perfusion imaging
  • 1. At least moderate ischemia involving \>10% of the LV myocardium or
  • 2. Global coronary flow reserve (CFR) \<1.8 or
  • 3. Stress myocardial blood flow (MBF) \<1.8
  • 2. Abnormal coronary angiography (invasive coronary angiography or coronary computed tomography)
  • 1. ≥ 50% stenosis in ≥ 2 coronary vessels or
  • 2. Diffuse atherosclerosis in a 3-vessel distribution
  • 3. Elevated coronary calcium score
  • 1. CAC \>100 + \>1 ASCVD risk factor
  • 2. CAC \>300
  • * If the patient is on a statin they must be on a stable dose for at least 3 months prior to enrollment.
  • * History of myocardial infarction or stroke
  • * CABG \< 3 months prior to screening
  • * Homozygous familial hypercholesterolemia
  • * History of cardiac transplantation
  • * LV ejection fraction \< 40% or New York Heart Failure Association (NYHA) class III-IV for angina and/or dyspnea.
  • * History of infiltrative or hypertrophic cardiomyopathy
  • * Severe valvular disease
  • * Uncontrolled or recurrent ventricular tachycardia
  • * Fasting triglycerides \> 500 mg/dL
  • * GFR ˂ 30 mL/min/1.73 m²
  • * Current use of a PCSK-9 inhibitor
  • * Currently pregnant or breastfeeding
  • * Contraindication to receive vasodilator agent
  • * Latex allergy

Ages Eligible for Study

50 Years to 90 Years

Sexes Eligible for Study

ALL

Accepts Healthy Volunteers

No

Collaborators and Investigators

Brigham and Women's Hospital,

Diana Lopez, MD, PRINCIPAL_INVESTIGATOR, Brigham and Women's Hospital

Study Record Dates

2025-12-31