CAPRA-EVO: a Randomized Serial PCCT Trial of Early Evolocumab After ACS

Inclusion Criteria: Eligible patients must meet the following criteria: * Age between 40 and 75 years. * Diagnosis of ACS, including ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI) or unstable angina (UA). * Successful PCI treatment, with post-procedural TIMI grade 3 flow and residual stenosis \<30% and atherosclerotic plaque presence in non-culprit coronary vessels (not attributed to this target event). * Suboptimal LDL-C control: Patients must have received any statin treatment for at least 4 weeks, with an LDL-C level ≥1.8 mmol/L; or Statin-naive patients must have an LDL-C level ≥3.2 mmol/L. * Agreement to complete baseline CCTA and laboratory tests within 7 days of enrollment and signed informed consent. * Commitment to complete 52 weeks of follow-up. Exclusion Criteria: * History of coronary artery bypass grafting (CABG). * History of valve surgery. * History of PCI treatment before the index ACS event * Complex bifurcation lesions (Medina 1,1,1). * Use of PCSK9 inhibitors (e.g., evolocumab, alirocumab) or potent CYP3A4 inhibitors (e.g., itraconazole) within the last 12 months. * Known intolerance to statins, evolocumab, or other investigational drugs related to the study. * Hepatic or renal insufficiency (eGFR \<60 mL/min/1.73m² or ALT/AST \>3 times the upper limit of normal). * Active autoimmune diseases (e.g., rheumatoid arthritis, systemic lupus erythematosus). * Uncontrolled heart failure (NYHA class III-IV) or malignant arrhythmias. * Known allergy or hypersensitivity to iodinated contrast media * Hyperthyroidism or active thyroid disease * Pregnancy or breastfeeding (or plans for pregnancy within the next year). * Life expectancy of less than 1 year (e.g., due to advanced malignancy). * Participation in another interventional clinical trial within the past 3 months.