Vytorin

This prospective, randomized, open label study was delineated to evaluate differences in the composition of lipids in patients with STEMI at D1 and at D30 after implementing the two lipid-lowering therapies (rosuvastatin 20 mg [Crestor, AstraZeneca] or simvastatin 40 mg combined with ezetimibe10 mg [Vytorin, MSD]). Plasma of patients were categorized in four groups: patients in the rosuvastatin group at D1 (G1) and at D30 (G2); patients treated with simvastatin + ezetimibe at D1 (G3) and at D30 (G4). These two lipid-lowering therapies were chosen to promote similar changes in the classic lipid profile, allowing the comparison of the more effective inhibition of cholesterol synthesis (rosuvastatin) with the combined mechanisms of LDL-C lowering (inhibition of cholesterol synthesis and inhibition of intestinal cholesterol absorption by simvastatin/ezetimibe). Patients were randomized 1:1 for the lipid-lowering therapy using a central computerized system (battle-ami.huhsp.org.br). All patients followed similar protocol, receiving dual antiplatelet therapies, betablockers, and renin-angiotensin system blockers and they were referred to coronary angiogram, and percutaneous coronary intervention, when needed, in the first 24 h of STEMI.

For this study, 101 consecutive patients of both sexes with their first myocardial infarction were included as part of the B And T Types of Lymphocyte Evaluation in Acute Myocardial Infarction (BATTLE-AMI study, NCT02428374) [23 (link)]. All patients underwent pharmacological thrombolysis in the first 6 h followed by coronary angiogram and percutaneous coronary intervention (PCI) when needed in the first 24 h of STEMI (pharmacoinvasive strategy). Patients with primary PCI were not included in this trial. The key exclusion criteria were clinical instability, use of lipid-lowering or immunosuppressant therapies, autoimmune disease, known malignancy, pregnancy or signs of active infections. After hospital admission, these patients were randomized to be treated with simvastatin 40 mg plus ezetimibe 10 mg qd (Vytorin®, MSD) or rosuvastatin 20 mg qd (Crestor®, AstraZeneca) using a central computerized system (battle-ami.huhsp.org.br).