Protective Effects of PCSK9 Inhibitors on Renal Function in ASCVD Patients at High Risk for Contrast-Associated Acute Kidney Injury

The present study explored the potential protective effects of a proprotein-converting enzyme subtilisin/kexin 9 inhibitor (evolocumab) against contrast-associated acute kidney injury (CA-AKI) in high-risk patients with atherosclerotic cardiovascular disease(ASCVD). This retrospective cohort study included patients who underwent percutaneous coronary intervention at Tianjin Chest Hospital between January 2020 and December 2021. The endpoint was the incidence of CA-AKI. Bias matching was used to mitigate the impact of selection bias and other potential confounding factors. This study included 1642 patients, with 821 receiving evolocumab treatment (subcutaneous injection of 140 mg evolocumab within 2 days before undergoing PCI) before contrast agent administration and 821 not receiving this treatment. The incidences of CA-AKI were 6.21% and 8.04% in the evolocumab and control groups, respectively (<i>P</i> = .150). After propensity score matching, the incidence was 4.52% and 8.47% in the evolocumab and control groups (<i>P</i> = .009), respectively. These findings suggest that evolocumab treatment significantly reduced the occurrence of CA-AKI. These results were consistent across the subgroups of individuals with varying risk scores. Evolocumab administration effectively reduces the incidence of CA-AKI in inpatients with ASCVD, with a notable effect in high-risk individuals with CA-AKI.