Moderate Intensity Statins Plus Ezetimibe Combination Therapy Versus High Intensity Statins Monotherapy After...

High-intensity statins are standard therapy after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS), yet tolerability concerns and residual cardiovascular risk remain important challenges. Moderate-intensity statin therapy combined with ezetimibe has emerged as a potential alternative, although its comparative effectiveness after PCI remains uncertain.

We performed a systematic review and meta-analysis according to PRISMA guidelines. PubMed, Cochrane Library, and ClinicalTrials.gov were searched through September 2025 for studies enrolling adults undergoing PCI and comparing moderate-intensity statin plus ezetimibe therapy with high-intensity statin therapy. The primary outcome was major adverse cardiovascular events (MACE), defined as all-cause mortality, myocardial infarction (MI), stroke, and revascularization. Secondary outcomes included individual cardiovascular endpoints and safety outcomes such as new-onset diabetes and rhabdomyolysis. Random-effects models were used to calculate pooled risk ratios (RRs).

Nine studies involving 179 621 patients were included, the majority being observational studies. No significant difference was observed in MACE between treatment strategies (RR 0.96, 95% CI 0.81-1.12). Modest reductions were observed in cardiovascular mortality (RR 0.83, 95% CI 0.71-0.98) and MI (RR 0.74, 95% CI 0.58-0.95), although findings were non-robust with wide prediction intervals. Revascularization rates were similar between groups. Subgroup analyses suggested lower heterogeneity in intermediate follow-up and non-ACS populations.

Moderate-intensity statin plus ezetimibe therapy may provide cardiovascular outcomes comparable to high-intensity statins after PCI. However, persistent heterogeneity limits certainty, and large randomized trials are needed to confirm long-term efficacy and safety.