The efficacy of dual lipid-lowering therapy with ezetimibe and statin on plaque volume regression among patients following percutaneous coronary intervention: a meta-analysis

Introduction Intensive lipid-lowering therapy is essential for patients at high or very high risk of coronary heart disease, yet many post-percutaneous coronary intervention patients fail to reach target LDL-C levels with statin monotherapy alone. Ezetimibe, a cholesterol absorption inhibitor, has been proposed as an adjunct to statins to enhance LDL-C reduction. This meta-analysis evaluates whether the combination of ezetimibe and statin offers superior coronary plaque volume regression compared with statin monotherapy in patients following PCI. Methods A systematic search was conducted for English-language randomized controlled trials published until October 2023 using the terms "Statin AND Ezetimibe AND percutaneous coronary intervention." The review exclusively included randomized controlled trials enrolling patients over 18 years old who underwent percutaneous coronary intervention, with primary outcomes focused on changes in lipid levels and inflammatory profiles, while excluding any non-randomized studies. Data extraction and risk-of-bias assessments were independently performed by two reviewers. Pooled analyses were conducted with RevMan 5.4.1, employing odds ratios with 95% confidence intervals and evaluating heterogeneity via the I² statistic. Results Five randomized trials met inclusion criteria. Although individual studies reported significant PV reduction with the combination therapy, the pooled analysis revealed no statistically significant difference in plaque volume regression between ezetimibe-statin combination therapy and statin monotherapy (I² = 0%, p = 0.85). Moreover, the degree of PV reduction was closely associated with the extent of LDL-C lowering, irrespective of the therapeutic strategy employed. Conclusion In post-PCI patients, adding ezetimibe to statin therapy did not demonstrate an incremental benefit in coronary plaque regression compared with statin monotherapy. These findings suggest that plaque volume reduction is primarily dependent on the magnitude of LDL-C lowering. Larger, long-term studies with standardized treatment protocols are warranted to further clarify the role of combination lipid-lowering therapy in this population.PRISMA Flow Chart of Literature Search . Forest plot of comparison