OBJECTIVE: It was unclear whether the clinical benefit of evolocumab extended to diabetic patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) in China. In this study, the safety and efficacy of evolocumab in treating diabetic patients with STEMI undergoing PCI was assessed. METHODS: A retrospective study was conducted involving 184 diabetic patients with STEMI PCI. The patients were assigned to either the evolocumab group or the control (Ctrl) group based on whether they were treated with evolocumab. After six months of treatment and 12 months of follow-up, the primary efficacy endpoint, blood lipid levels, and adverse events were evaluated. Additionally, a prognostic model was developed to examine the relationship between evolocumab intervention and primary efficacy endpoint. RESULTS: Blood lipid levels and intima-media thickness decreased significantly and the LVEF levels increased significantly in patients after treatment with evolocumab compared to those in patients after administering a standard therapy. Treatment with evolocumab also led to a significant reduction in the primary efficacy endpoint. Moreover, no difference in the incidence of adverse reactions was recorded between the groups. The prognostic model constructed showed that evolocumab intervention was a protective factor for the primary efficacy endpoint. CONCLUSIONS: Administering evolocumab had greater benefits for diabetic patients with STEMI undergoing PCI. Our findings might encourage doctors to consider use evolocumab to reduce the risk of future cardiovascular events in diabetic patients with STEMI.