Title

Usefulness of baseline statin therapy in nonobstructive coronary artery disease by coronary computed tomographic angiography: From the CONFIRM (COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter) study

Authors

Yun Kyeong Cho, Keimyung University, Dongsan Medical Center
Chang Wook Nam, Keimyung University, Dongsan Medical Center
Bon Kwon Koo, Seoul National University
Joshua Schulman-Marcus, New York Presbyterian Hospital
Bríain Hartaigh, New York Presbyterian Hospital
Heidi Gransar, Cedars-Sinai Medical Center
Yao Lu, New York Presbyterian Hospital
Stephan Achenbach, Friedrich-Alexander-Universität Erlangen-Nürnberg
Mouaz Al-Mallah, King Saud bin Abdulaziz University for Health Sciences
Daniele Andreini, IRCCS Centro Cardiologico Monzino
Jeroen J. Bax, Leiden University Medical Center - LUMC
Matthew J. Budoff, The Lundquist Institute
Filippo Cademartiri, IRCCS Fondazione SDN
Tracy Q. Callister, Tennessee Heart and Vascular Institute
Hyuk Jae Chang, Severance Hospital
Kavitha Chinnaiyan, William Beaumont Hospital
Benjamin J.W. Chow, University of Ottawa, Canada
Ricardo C. Cury, Baptist Cardiac and Vascular Institute
Augustin Delago, Capitol Cardiology Associates
Gudrun Feuchtner, Medizinische Universitat Innsbruck
Martin Hadamitzky, Deutsches Herzzentrum München
Jörg Hausleiter, Ludwig-Maximilians-Universität München
Philipp A. Kaufmann, UniversitatsSpital Zurich
Yong Jin Kim, Seoul National University
Jonathon Leipsic, The University of British Columbia
Erica Maffei
Hugo Marques, Hospital da Luz
Gianluca Pontone, IRCCS Centro Cardiologico Monzino
Gilbert L. Raff, William Beaumont Hospital
Ronen Rubinshtein, Technion - Israel Institute of Technology
Leslee J. Shaw, New York Presbyterian Hospital
Todd C. Villines, Walter Reed National Military
Daniel S. Berman, Cedars-Sinai Medical Center

Document Type

Article

Publication Date

12-1-2018

Publication Title

PLoS ONE

Abstract

© 2018 Cho et al.This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background The extent to which the presence and extent of subclinical atherosclerosis by coronary computed tomography angiography influences a potential mortality benefit of statin is unknown. We evaluated the relationship between statin therapy, mortality, and subclinical atherosclerosis. Methods In the CONFIRM study, patients with normal or non-obstructive plaque (<50% diameter stenosis) for whom data on baseline statin use was available were included. Coronary artery calcium (CAC) was quantified using the Agatston score. The extent of non-obstructive coronary atherosclerosis was quantified using the segment involvement score (SIS). 8,016 patients were followed for a median of 2.5 years with analysis of all-cause mortality and major adverse cardiac events (MACE) including all-cause mortality, myocardial infarction, unstable angina, target vessel revascularization, and coronary artery disease-related hospitalization. Results 1.2% of patients experienced all-cause mortality. Patients not on baseline statin therapy had a stepwise increased risk of all-cause mortality by CAC (relative to CAC = 0; CAC 1-99: Hazard ratio [HR] 1.65, CAC 100-299: HR 2.19, and CAC≥300: HR 2.98) or SIS (relative to SIS = 0; SIS 1: HR 1.62, SIS 2-3: 2.48 and SIS≥4: 2.95). Conversely, in patients on baseline statin therapy, there was no significant increase in mortality risk with increasing CAC (p value for interaction = 0.049) or SIS (p value for interaction = 0.007). The incidence of MACE was 2.1%. Similar to the all-cause mortality, the risk of MACE was increased with CAC or SIS strata in patient not on baseline statin therapy. However, this relation was not observed in patient on baseline statin therapy. Conclusion In individuals with non-obstructive coronary artery disease, increased risk of adverse events occurs with increasing CAC or SIS who are not on baseline statin therapy. Statin therapy is associated with a mitigation of risk of cardiac events in the presence of increasing atherosclerosis, with no particular threshold of disease burden.

Volume

13

Issue

12

DOI

10.1371/journal.pone.0207194

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