In Reply We thank the letter writers for their interest in our article.1 We appreciate the amplification of our observations related to procedural myocardial infarction (MI) being reduced by evolocumab by Alkhalil, suggesting a role of underlying plaque content, stability, and morphology in addition to procedural characteristics.2 We agree that understanding the biology is of interest and that there are several plausible mechanisms; however, data from clinical outcomes trials, including the timing of separation of event curves, cannot serve to inform this mechanistic question and await further studies.
Wiviott SD, Giugliano RP, Sabatine MS. Myocardial Infarction and Evolocumab—Reply. JAMA Cardiol. 2021;6(10):1222–1223. doi:10.1001/jamacardio.2021.2000
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