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

Journal article


Publication Details

Author(s): 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
Journal: PLoS ONE
Publication year: 2018
Volume: 13
Journal issue: 12
ISSN: 1932-6203


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.


FAU Authors / FAU Editors

Achenbach, Stephan Prof. Dr. med.
Lehrstuhl für Innere Medizin II


External institutions with authors

Baptist Health South Florida
Beaumont Health System
Capitol Cardiology Associates
Cedars-Sinai Medical Center
Cornell University
Deutsches Herzzentrum München
Hospital da Luz
Istituto di ricovero e cura a carattere scientifico (IRCCS)
Keimyung University (KMU)
King Abdullah International Medical Research Center (KAIMRC)
Leiden University
Ludwig-Maximilians-Universität (LMU)
Medizinische Universität Innsbruck
New York Presbyterian Hospital
Seoul National University (SNU) / 서울대학교
Technion - Israel Institute of Technology
Tennessee Heart & Vascular
Universitätsspital Zürich (USZ)
University of British Columbia
University of California Los Angeles (UCLA)
University of Ottawa
Walter Reed National Military Medical Center
Yonsei University Health System (YUHS)


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://dx.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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Last updated on 2019-06-03 at 10:23