Prognostic and Therapeutic Implications of Statin and Aspirin Therapy in Individuals With Nonobstructive Coronary Artery Disease
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Published:2015-04
Issue:4
Volume:35
Page:981-989
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ISSN:1079-5642
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Container-title:Arteriosclerosis, Thrombosis, and Vascular Biology
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language:en
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Short-container-title:ATVB
Author:
Chow Benjamin J.W.1, Small Gary1, Yam Yeung1, Chen Li1, McPherson Ruth1, Achenbach Stephan1, Al-Mallah Mouaz1, Berman Daniel S.1, Budoff Matthew J.1, Cademartiri Filippo1, Callister Tracy Q.1, Chang Hyuk-Jae1, Cheng Victor Y.1, Chinnaiyan Kavitha1, Cury Ricardo1, Delago Augustin1, Dunning Allison1, Feuchtner Gundrun1, Hadamitzky Martin1, Hausleiter Jörg1, Karlsberg Ronald P.1, Kaufmann Philipp A.1, Kim Yong-Jin1, Leipsic Jonathon1, LaBounty Troy1, Lin Fay1, Maffei Erica1, Raff Gilbert L.1, Shaw Leslee J.1, Villines Todd C.1, Min James K.1
Affiliation:
1. From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C., R.M.); Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); Department of Medicine, Henry Ford Hospital, Wayne State University, Detroit, MI (M.A.-M.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.Y.C., T.L.); Department of Medicine, Harbor University of California, Los Angeles Medical Center (M.J.B.);...
Abstract
Objective—
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.
Approach and Results—
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.
Conclusions—
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.
Clinical Trial Registration—
URL:
http://clinicaltrials.gov/
. Unique identifier NCT01443637
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
146 articles.
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