Korean J Radiol.  2019 Jul;20(7):1156-1166. 10.3348/kjr.2018.0016.

Subclinical Coronary Atherosclerosis: Implication of Coronary Computed Tomography Angiography Findings among Statin Candidates according to the 2013 ACC/AHA Cholesterol Management Guidelines

• Seo J
• Choi SI
• Kim YK

• KMID: 2467026
• DOI: http://doi.org/10.3348/kjr.2018.0016

Abstract

OBJECTIVE
To analyze the cardiovascular outcome of statin medication in individuals retrospectively categorized on the basis of the 2013 American College of Cardiology and American Heart Association (ACC/AHA) guidelines risk assessment and to determine the additional prognostic value of coronary computed tomography angiography (CCTA) in assessing cardiovascular disease (CVD) risk in this group.
MATERIALS AND METHODS
This retrospective study reviewed 4255 asymptomatic individuals who had undergone self-referred CCTA with a median follow-up period of 87 months. The primary endpoint was major adverse cardiac events (MACEs); these included cardiac death, nonfatal myocardial infarction, and unstable angina. Individuals recommended for statins according to the ACC/AHA guidelines were analyzed by their assessed risk.
RESULTS
MACE occurrence was significantly higher in the statin-recommended (SR) group with significant coronary artery disease (CAD) than in those with insignificant CAD (p < 0.001). In individuals with a normal coronary artery on CCTA, MACEs did not occur regardless of statin medication. In the SR group with significant CAD, there was no significant difference between statin users and non-users (p = 0.810). However, in cases with insignificant CAD, the event-free survival was significantly lower among statin users (p = 0.034). In patients recommended for moderate-intensity statins, the segment involvement score on CCTA was significantly associated with a higher risk of MACEs (hazard ratio 2.558; p = 0.001).
CONCLUSION
CCTA might have a potential role in CVD risk stratification among asymptomatic statin candidates.

Keyword

Coronary artery; Coronary CT angiography; Statin; Atherosclerosis

MeSH Terms

American Heart Association
Angina, Unstable
Angiography*
Atherosclerosis
Cardiology
Cardiovascular Diseases
Cholesterol*
Coronary Artery Disease*
Coronary Vessels
Death
Disease-Free Survival
Follow-Up Studies
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors*
Myocardial Infarction
Retrospective Studies
Risk Assessment
Cholesterol

Figure

• 

  Fig. 1 Comparison of statin prescription between recommended intensities in SR groups.*Statin prescription of lower intensity statin compared to guideline, †Statin prescription of same or higher intensity statin compared to guideline. SR = statin-recommended

• 

  Fig. 2 Event-free survival curve of patients with stratification of prescribed statin intensity in SR group.Kaplan-Meier survival curves of each group are shown; (A) all subjects in SR group, (B) group B, (C) group B with insignificant coronary stenosis, (D) group B with significant coronary stenosis, (E) group C, (F) group C with insignificant coronary stenosis, and (G) group C with significant coronary stenosis.

• 

  Fig. 3 Event-free survival curve of patients with stratification of CAD in SR group.Kaplan-Meier survival curves of each group are shown; (A) all subjects in SR group, (B) subjects with medication, (C) subjects without medication. CAD = coronary artery disease

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