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

Cho YK, Nam CW, Koo BK, Schulman-Marcus J, Hartaigh BO, Gransar H, Lu Y, Achenbach S, Al-Mallah M, Andreini D, Bax JJ, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow BJW, Cury RC, Delago A, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufmann PA, Kim YJ, Leipsic J, Maffei E, Marques H, Pontone G, Raff GL, Rubinshtein R, Shaw LJ, Villines TC, Berman DS, Jones EC, Pena JM, Lin FY, Min JK (2018)

Publication Type: Journal article

Publication year: 2018

Journal

Book Volume: 13

Journal Issue: 12

DOI: 10.1371/journal.pone.0207194

Abstract

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.

Authors with CRIS profile

Involved external institutions

Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR) Hospital da Luz Portugal (PT) Medizinische Universität Innsbruck Austria (AT) Cedars-Sinai Medical Center United States (USA) (US) New York Presbyterian Hospital United States (USA) (US) Walter Reed National Military Medical Center United States (USA) (US) Technion - Israel Institute of Technology Israel (IL) Beaumont Health System United States (USA) (US) Capitol Cardiology Associates United States (USA) (US) Ludwig-Maximilians-Universität (LMU) Germany (DE) Istituto di ricovero e cura a carattere scientifico (IRCCS) Italy (IT) Deutsches Herzzentrum München Germany (DE) University of British Columbia Canada (CA) Universitätsspital Zürich (USZ) Switzerland (CH) Leiden University Netherlands (NL) Tennessee Heart & Vascular United States (USA) (US) Keimyung University (KMU) Korea, Republic of (KR) University of California Los Angeles (UCLA) United States (USA) (US) Yonsei University Health System (YUHS) Korea, Republic of (KR) Cornell University United States (USA) (US) King Abdullah International Medical Research Center (KAIMRC) Saudi Arabia (SA) University of Ottawa Canada (CA) Baptist Health South Florida United States (USA) (US)

How to cite

APA:

Cho, Y.-K., Nam, C.-W., Koo, B.-K., Schulman-Marcus, J., Hartaigh, B.O., Gransar, H.,... Min, J.K. (2018). Usefulness of baseline statin therapy in non-obstructive coronary artery disease by coronary computed tomographic angiography: From the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) study. PLoS ONE, 13(12). https://doi.org/10.1371/journal.pone.0207194

MLA:

Cho, Yun-Kyeong, et al. "Usefulness of baseline statin therapy in non-obstructive coronary artery disease by coronary computed tomographic angiography: From the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) study." PLoS ONE 13.12 (2018).

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