Effect of Pre-Procedural Statin/Ezetimibe Combination Therapy Versus Statin Monotherapy on Myocardial No-Reflow Following Percutaneous Coronary Intervention in Patients with Acute ST-Segment Elevation Myocardial Infarction: A Randomized Controlled Cl

Abstract Aim and Objectives The aim of the study was to compare the effectiveness of pre- procedural Statin therapy and Statin/Ezetimibe in reducing the no-reflow phenomenon in patients undergoing primary PCI. Patients and Methods The study was carried out on 200 patients (age 55.86 ± 11.32) presenting to Ain Shams university hospitals with ST-segment elevation Myocardial Infarction and received the standard of care management which is Primary PCI. The patients were assessed regarding the demographic data, risk factors, symptoms including characterization of chest pain, physical examination, 12 lead ECG, labs, Coronary angiography to identify the coronary anatomy, culprit vessel, TIMI flow score and MBG. Results Our study compared 100 patients who received high intensity Statin/Ezetimibe combination before primary PCI and 100 patients who received high intensity statin only. Among the case group, 72% were smokers, 33% were diabetic and 24% were hypertensive, 94% presented with killip 1, 5 with killip 2, 1% with killip 3, 70% were anterior STEMI, 2% Lateral, 18% inferior and 10% posterior. Among the control group 75% were smokers, 18% were diabetic and 24% were hypertensive, 95 % presented with killip 1, 3% with killip 2, 2% with killip 3, 49% were anterior STEMI, 6% Lateral, 34% inferior and 11% posterior. The study revealed that there was no statistically significant difference between the two groups, group A (case group) and group B (control group) regarding the occurrence of no reflow, 7 no reflow patients in group A versus 8 in group B, with a P-value of 0.788. There was no significant difference between the two groups in the tissue perfusion post primary PCI as being assessed by TIMI flow classification and myocardial blush grade. Conclusion Statin/Ezetimibe combination did not result in a significant reduction in the incidence of no-reflow in STEMI patients in comparison to Statins alone. Although the occurrence of MACE was less in the case group, the exact effect on in-hospital MACE could not be detected due to the small number of total MACE in the study. Larger additional randomized studies are needed to establish the effect of preprocedural high-dose Statin/Ezetimibe combination therapy on angiographic results in patients who undergo primary PCI.