Prognostic and therapeutic implications of statin and aspirin therapy in individuals with nonobstructive coronary artery disease: results from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter registry) re

Chow BJW, Small G, Yam Y, Chen L, Mcpherson R, Achenbach S, Al-Mallah M, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Cheng VY, Chinnaiyan K, Cury R, Delago A, Dunning A, Feuchtner G, Hadamitzky M, Hausleiter J, Karlsberg RP, Kaufmann PA, Kim YJ, Leipsic J, Labounty T, Lin F, Maffei E, Ralf GL, Shaw LJ, Villines TC, Min JK (2015)

Publication Type: Journal article

Publication year: 2015

Journal

Book Volume: 35

Pages Range: 981-9

Journal Issue: 4

DOI: 10.1161/ATVBAHA.114.304351

Abstract

We sought to examine the risk of mortality associated with nonobstructive coronary artery disease (CAD) and to determine the impact of baseline statin and aspirin use on mortality.Coronary computed tomographic angiography permits direct visualization of nonobstructive CAD. To date, the prognostic implications of nonobstructive CAD and the potential benefit of directing therapy based on nonobstructive CAD have not been carefully examined. A total of 27 125 consecutive patients who underwent computed tomographic angiography (12 enrolling centers and 6 countries) were prospectively entered into the COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry. Patients, without history of previous CAD or obstructive CAD, for whom baseline statin and aspirin use was available were analyzed. Each coronary segment was classified as normal or nonobstructive CAD (1%-49% stenosis). Patients were followed up for a median of 27.2 months for all-cause mortality. The study comprised 10 418 patients (5712 normal and 4706 with nonobstructive CAD). In multivariable analyses, patients with nonobstructive CAD had a 6% (95% confidence interval, 1%-12%) higher risk of mortality for each additional segment with nonobstructive plaque (P=0.021). Baseline statin use was associated with a reduced risk of mortality (hazard ratio, 0.44; 95% confidence interval, 0.28-0.68; P=0.0003), a benefit that was present for individuals with nonobstructive CAD (hazard ratio, 0.32; 95% confidence interval, 0.19-0.55; P<0.001) but not for those without plaque (hazard ratio, 0.66; 95% confidence interval, 0.30-1.43; P=0.287). When stratified by National Cholesterol Education Program/Adult Treatment Program III, no mortality benefit was observed in individuals without plaque. Aspirin use was not associated with mortality benefit, irrespective of the status of plaque.The presence and extent of nonobstructive CAD predicted mortality. Baseline statin therapy was associated with a significant reduction in mortality for individuals with nonobstructive CAD but not for individuals without CAD.URL: http://clinicaltrials.gov/. Unique identifier NCT01443637.

Authors with CRIS profile

Involved external institutions

Harbor–UCLA Medical Center United States (USA) (US) New York Presbyterian Hospital United States (USA) (US) Walter Reed Army Medical Center (WRAMC) United States (USA) (US) Emory University United States (USA) (US) Beaumont Health System United States (USA) (US) Casa di Cura Giovanni XXIII Italy (IT) Cedars-Sinai Medical Center United States (USA) (US) University of British Columbia Canada (CA) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR) Universitätsspital Zürich (USZ) Switzerland (CH) Cardiovascular Medical Group of Southern California United States (USA) (US) Technische Universität München (TUM) Germany (DE) Medizinische Universität Innsbruck Austria (AT) Capitol Cardiology Associates United States (USA) (US) Baptist Health South Florida United States (USA) (US) Yonsei University Health System (YUHS) Korea, Republic of (KR) Tennessee Heart & Vascular United States (USA) (US) Wayne State University (WSU) United States (USA) (US) University of Ottawa Canada (CA)

How to cite

APA:

Chow, B.J.W., Small, G., Yam, Y., Chen, L., Mcpherson, R., Achenbach, S.,... Min, J.K. (2015). Prognostic and therapeutic implications of statin and aspirin therapy in individuals with nonobstructive coronary artery disease: results from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter registry) re. Arteriosclerosis, Thrombosis, and Vascular Biology, 35(4), 981-9. https://doi.org/10.1161/ATVBAHA.114.304351

MLA:

Chow, Benjamin J. W., et al. "Prognostic and therapeutic implications of statin and aspirin therapy in individuals with nonobstructive coronary artery disease: results from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter registry) re." Arteriosclerosis, Thrombosis, and Vascular Biology 35.4 (2015): 981-9.

BibTeX: Download