Usefulness of baseline statin therapy in nonobstructive coronary artery disease by coronary computed tomographic angiography

From the CONFIRM (COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter) study

Yun Kyeong Cho, Chang Wook Nam, Bon Kwon Koo, Joshua Schulman-Marcus, Bríain Hartaigh, Heidi Gransar, Yao Lu, Stephan Achenbach, Mouaz Al-Mallah, Daniele Andreini, Jeroen J. Bax, Matthew J. Budoff, Filippo Cademartiri, Tracy Q. Callister, Hyuk Jae Chang, Kavitha Chinnaiyan, Benjamin J.W. Chow, Ricardo C. Cury, Augustin Delago, Gudrun Feuchtner & 17 others Martin Hadamitzky, Jörg Hausleiter, Philipp A. Kaufmann, Yong Jin Kim, Jonathon Leipsic, Erica Maffei, Hugo Marques, Gianluca Pontone, Gilbert L. Raff, Ronen Rubinshtein, Leslee J. Shaw, Todd C. Villines, Daniel S. Berman, Erica C. Jones, Jessica M. Peña, Fay Y. Lin, James K. Min

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

Original languageEnglish
Article numbere0207194
JournalPLoS One
Volume13
Issue number12
DOIs
Publication statusPublished - Dec 1 2018

Fingerprint

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Angiography
coronary vessels
Coronary Angiography
Multicenter Studies
Coronary Artery Disease
Coronary Vessels
calcium
therapeutics
Calcium
Mortality
atherosclerosis
Hazards
Therapeutics
Atherosclerosis
burden of disease
Computed Tomography Angiography
coronary artery disease
myocardial infarction
risk reduction

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Usefulness of baseline statin therapy in nonobstructive coronary artery disease by coronary computed tomographic angiography : From the CONFIRM (COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter) study. / Cho, Yun Kyeong; Nam, Chang Wook; Koo, Bon Kwon; Schulman-Marcus, Joshua; Hartaigh, Bríain; Gransar, Heidi; Lu, Yao; Achenbach, Stephan; Al-Mallah, Mouaz; Andreini, Daniele; Bax, Jeroen J.; Budoff, Matthew J.; Cademartiri, Filippo; Callister, Tracy Q.; Chang, Hyuk Jae; Chinnaiyan, Kavitha; Chow, Benjamin J.W.; Cury, Ricardo C.; Delago, Augustin; Feuchtner, Gudrun; Hadamitzky, Martin; Hausleiter, Jörg; Kaufmann, Philipp A.; Kim, Yong Jin; Leipsic, Jonathon; Maffei, Erica; Marques, Hugo; Pontone, Gianluca; Raff, Gilbert L.; Rubinshtein, Ronen; Shaw, Leslee J.; Villines, Todd C.; Berman, Daniel S.; Jones, Erica C.; Peña, Jessica M.; Lin, Fay Y.; Min, James K.

In: PLoS One, Vol. 13, No. 12, e0207194, 01.12.2018.

Research output: Contribution to journalArticle

Cho, YK, Nam, CW, Koo, BK, Schulman-Marcus, J, Hartaigh, B, 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, Peña, JM, Lin, FY & Min, JK 2018, 'Usefulness of baseline statin therapy in nonobstructive coronary artery disease by coronary computed tomographic angiography: From the CONFIRM (COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter) study', PLoS One, vol. 13, no. 12, e0207194. https://doi.org/10.1371/journal.pone.0207194
Cho, Yun Kyeong ; Nam, Chang Wook ; Koo, Bon Kwon ; Schulman-Marcus, Joshua ; Hartaigh, Bríain ; Gransar, Heidi ; Lu, Yao ; Achenbach, Stephan ; Al-Mallah, Mouaz ; Andreini, Daniele ; Bax, Jeroen J. ; Budoff, Matthew J. ; Cademartiri, Filippo ; Callister, Tracy Q. ; Chang, Hyuk Jae ; Chinnaiyan, Kavitha ; Chow, Benjamin J.W. ; Cury, Ricardo C. ; Delago, Augustin ; Feuchtner, Gudrun ; Hadamitzky, Martin ; Hausleiter, Jörg ; Kaufmann, Philipp A. ; Kim, Yong Jin ; Leipsic, Jonathon ; Maffei, Erica ; Marques, Hugo ; Pontone, Gianluca ; Raff, Gilbert L. ; Rubinshtein, Ronen ; Shaw, Leslee J. ; Villines, Todd C. ; Berman, Daniel S. ; Jones, Erica C. ; Peña, Jessica M. ; Lin, Fay Y. ; Min, James K. / Usefulness of baseline statin therapy in nonobstructive coronary artery disease by coronary computed tomographic angiography : From the CONFIRM (COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter) study. In: PLoS One. 2018 ; Vol. 13, No. 12.
@article{794db15901904eac8b11ba562c2caa72,
title = "Usefulness of baseline statin therapy in nonobstructive coronary artery disease by coronary computed tomographic angiography: From the CONFIRM (COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter) study",
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.",
author = "Cho, {Yun Kyeong} and Nam, {Chang Wook} and Koo, {Bon Kwon} and Joshua Schulman-Marcus and Br{\'i}ain Hartaigh and Heidi Gransar and Yao Lu and Stephan Achenbach and Mouaz Al-Mallah and Daniele Andreini and Bax, {Jeroen J.} and Budoff, {Matthew J.} and Filippo Cademartiri and Callister, {Tracy Q.} and Chang, {Hyuk Jae} and Kavitha Chinnaiyan and Chow, {Benjamin J.W.} and Cury, {Ricardo C.} and Augustin Delago and Gudrun Feuchtner and Martin Hadamitzky and J{\"o}rg Hausleiter and Kaufmann, {Philipp A.} and Kim, {Yong Jin} and Jonathon Leipsic and Erica Maffei and Hugo Marques and Gianluca Pontone and Raff, {Gilbert L.} and Ronen Rubinshtein and Shaw, {Leslee J.} and Villines, {Todd C.} and Berman, {Daniel S.} and Jones, {Erica C.} and Pe{\~n}a, {Jessica M.} and Lin, {Fay Y.} and Min, {James K.}",
year = "2018",
month = "12",
day = "1",
doi = "10.1371/journal.pone.0207194",
language = "English",
volume = "13",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "12",

}

TY - JOUR

T1 - Usefulness of baseline statin therapy in nonobstructive coronary artery disease by coronary computed tomographic angiography

T2 - From the CONFIRM (COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter) study

AU - Cho, Yun Kyeong

AU - Nam, Chang Wook

AU - Koo, Bon Kwon

AU - Schulman-Marcus, Joshua

AU - Hartaigh, Bríain

AU - Gransar, Heidi

AU - Lu, Yao

AU - Achenbach, Stephan

AU - Al-Mallah, Mouaz

AU - Andreini, Daniele

AU - Bax, Jeroen J.

AU - Budoff, Matthew J.

AU - Cademartiri, Filippo

AU - Callister, Tracy Q.

AU - Chang, Hyuk Jae

AU - Chinnaiyan, Kavitha

AU - Chow, Benjamin J.W.

AU - Cury, Ricardo C.

AU - Delago, Augustin

AU - Feuchtner, Gudrun

AU - Hadamitzky, Martin

AU - Hausleiter, Jörg

AU - Kaufmann, Philipp A.

AU - Kim, Yong Jin

AU - Leipsic, Jonathon

AU - Maffei, Erica

AU - Marques, Hugo

AU - Pontone, Gianluca

AU - Raff, Gilbert L.

AU - Rubinshtein, Ronen

AU - Shaw, Leslee J.

AU - Villines, Todd C.

AU - Berman, Daniel S.

AU - Jones, Erica C.

AU - Peña, Jessica M.

AU - Lin, Fay Y.

AU - Min, James K.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85058417453&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058417453&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0207194

DO - 10.1371/journal.pone.0207194

M3 - Article

VL - 13

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 12

M1 - e0207194

ER -