Aspirin and Statin Therapy for Nonobstructive Coronary Artery Disease: Five-yearOutcomes from the CONFIRM Registry

Indraratna P, Naoum C, Zekry SB, Gransar H, Blanke P, Sellers S, Achenbach S, Al-Mallah MH, Andreini D, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow BJ, Cury RC, Delago A, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufmann PA, Kim YJ, Maffei E, Marques H, De Araujo Gonsalves P, Pontone G, Raff GL, Rubinshtein R, Villines TC, Lin FY, Shaw LJ, Narula J, Bax JJ, Leipsic JA (2022)

Publication Type: Journal article

Publication year: 2022

Journal

Book Volume: 4

Article Number: e210225

Journal Issue: 2

DOI: 10.1148/ryct.210225

Abstract

Purpose: In this cohort study, 5-year data from the Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry (ie, CONFIRM) were examined to identify associations of baseline aspirin and statin use with mortality, major adverse cardiovascular events (MACE), and myocardial infarction (MI) in individuals without substantial (>50%) stenosis. Materials and Methods: In this prospective cohort study, all participants in the registry underwent coronary CT angiography and were classified as having no detectable coronary plaque or having nonobstructive coronary artery disease (CAD) (1%—49% stenosis). Participants with obstructive (>50%) stenosis were excluded from analysis. The study commenced in June 2003 and was completed in March 2016. All unadjusted and risk-adjusted analyses utilized the Cox proportional hazard model with hospital sites modeled using shared frailty. Results: A total of 6386 participants with no detectable plaque or with nonobstructive CAD were included (mean age, 56.0 years 6 13.3 [SD], 52% men). The mean follow-up period was 5.66 years 6 1.10. Nonobstructive CAD (n = 2815, 44% of all participants included in the study) was associated with a greater risk of all-cause mortality (10.6% [298 of 2815] vs 4.8% [170 of 3571], P <.001) compared to those without CAD (n = 3571, 56%). Baseline aspirin and statin use was documented for 1415 and 1429 participants, respectively, with nonobstructive CAD, and for 1560 and 1565 participants without detectable plaque, respectively. In individuals with nonobstructive CAD, baseline aspirin use was not associated with a reduction in MACE (10.9% [102 of 936] vs 14.7% [52 of 355], P =.06), all-cause mortality (9.6% [95 of 991] vs 10.9% [46 of424], P =.468), or MI (4.4% [41 of 936] vs 6.2% [22 of 355], P =.18). On multivariate risk-adjusted analysis, baseline statin use was associated with a lower rate of MACE (hazard ratio, 0.59; 95% CI: 0.40, 0. 87; P =.007). Neither therapy improved clinical outcomes for participants with no detectable plaque. Conclusion: In participants with nonobstructive CAD, baseline use of statins, but not of aspirin, was associated with improved clinical outcomes. Neither therapy was associated with benefit in participants without plaque. Clinical trial registration no. NCT01443637 Supplemental material is available for this article.

Authors with CRIS profile

Involved external institutions

Concord Repatriation General Hospital Australia (AU) Universitätsspital Zürich (USZ) Switzerland (CH) Severance Hospital / 세브란스 병원 Korea, Republic of (KR) Los Angeles Biomedical Research Institute (LA BioMed) United States (USA) (US) University of British Columbia Canada (CA) Centro Cardiologico Monzino (IRCCS) Italy (IT) Capitol Cardiology Associates United States (USA) (US) Tennessee Heart & Vascular United States (USA) (US) University of Ottawa Canada (CA) Baptist Health South Florida United States (USA) (US) Deutsches Herzzentrum München Germany (DE) Houston Methodist United States (USA) (US) Beaumont Health United States (USA) (US) SDN Istituto di Ricerca Diagnostica e Nucleare Italy (IT) Klinikum der Universität München Germany (DE) Medizinische Universität Innsbruck Austria (AT) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR) University of Virginia (UVA) United States (USA) (US) Mount Sinai Hospital United States (USA) (US) Technion - Israel Institute of Technology Israel (IL) Hospital da Luz Portugal (PT) Leiden University Medical Center Netherlands (NL) Weill Cornell Medicine United States (USA) (US)

How to cite

APA:

Indraratna, P., Naoum, C., Zekry, S.B., Gransar, H., Blanke, P., Sellers, S.,... Leipsic, J.A. (2022). Aspirin and Statin Therapy for Nonobstructive Coronary Artery Disease: Five-yearOutcomes from the CONFIRM Registry. Radiology: Cardiothoracic Imaging, 4(2). https://dx.doi.org/10.1148/ryct.210225

MLA:

Indraratna, Praveen, et al. "Aspirin and Statin Therapy for Nonobstructive Coronary Artery Disease: Five-yearOutcomes from the CONFIRM Registry." Radiology: Cardiothoracic Imaging 4.2 (2022).

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