Efficacy of Ezetimibe–Statin Combination Therapy versus Statin Monotherapy in ACS Patients Undergoing PCI: A Systematic Review and Meta-Analysis

Abstract

This systematic review and meta-analysis evaluated the comparative efficacy of ezetimibe–statin combination therapy versus statin monotherapy in improving lipid profiles and cardiovascular outcomes in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). A comprehensive search across four databases yielded eight eligible studies comprising a total of 4,588 patients. Using a random-effects model, combination therapy was found to significantly reduce low-density lipoprotein cholesterol (LDL-C) (SMD −0.32; 95% CI: −0.50 to −0.15; P < 0.001) and total cholesterol (TC) (SMD −0.27; 95% CI: −0.53 to −0.01; P = 0.05) compared to statin monotherapy. No significant differences were observed in high-density lipoprotein cholesterol (HDL-C) (SMD 0.05; 95% CI: −0.13 to 0.23; P = 0.59), triglycerides (TG) (SMD 0.09; 95% CI: −0.27 to 0.08; P = 0.30), or major adverse cardiovascular events (MACE) (RR 1.61; 95% CI: 0.75 to 3.47; P = 0.22). These results suggest that ezetimibe in combination with statins is superior in lipid-lowering efficacy but does not translate into a statistically significant reduction in cardiovascular events. Further high-quality, large-scale randomized trials are warranted to assess the long-term cardiovascular benefits of combination therapy in this population.