Moderate-Intensity Atorvastatin and Ezetimibe Combination Therapy Versus High-Intensity Atorvastatin in Patients with Angina Pectoris who Underwent Percutaneous Coronary Intervention

Abstract

BackgroundWhether moderate-intensity statin and ezetimibe combination therapy is beneficial compared to high-intensity statin monotherapy in patients with angina pectoris who underwent percutaneous coronary intervention (PCI) remains unclear. We aimed to investigate the effect of moderate-intensity atorvastatin with ezetimibe combination therapy after PCI in patients with angina pectoris, but not myocardial infarction (MI), in real-world practice.MethodsThis retrospective cohort study used data from the Korean National Health Insurance Database. Altogether 6784 patients who underwent PCI between 2015 and 2018 received either moderate-intensity atorvastatin (10 and 20 mg) and ezetimibe 10 mg (n = 4682) or high-intensity atorvastatin (40 and 80 mg; n = 2102). The primary outcome was a composite of cardiovascular death, MI, coronary revascularization, and stroke. Subgroup analyses were performed on the basis of baseline comorbidities.ResultsDuring the follow-up (mean duration of 4 years), incidence rates of the primary outcome were 70.14 and 62.05 per 1000 person-years in the moderate-intensity atorvastatin plus ezetimibe and high-intensity atorvastatin groups, respectively, with no significant differences in the risk of primary outcome between the two groups [hazard ratio (HR), 0.99; 95% confidence interval (CI) 0.90-1.10]. However, in patients with underlying chronic kidney disease (CKD), moderate-intensity atorvastatin with ezetimibe combination therapy was associated with a lower risk of primary outcome compared to high-intensity atorvastatin therapy (HR 0.40, 95% CI 0.18-0.86).ConclusionIn this real-world cohort study, there was no significant difference in cardiovascular outcomes between moderate-intensity atorvastatin plus ezetimibe combination therapy and high-intensity atorvastatin monotherapy in patients with angina pectoris who underwent PCI. Moderate-intensity atorvastatin and ezetimibe combination therapy may be beneficial, particularly in patients with CKD.