Lipid-lowering medication in patients with suspected CAD and percent atheroma volume >5% was associated with a lower annual rate of death, MI, or unstable angina (2.62% vs 4.14%; P=0.002).
Cohort (n=2,269)
Does lipid-lowering medication reduce the composite of death, myocardial infarction, and unstable angina in symptomatic patients with suspected CAD undergoing CCTA?
AI-guided quantification of coronary plaque burden (percent atheroma volume >5%) on CCTA identifies symptomatic patients with suspected CAD who derive prognostic benefit from lipid-lowering medication, even in the absence of obstructive CAD.
Absolute Event Rate: 2.62% vs 4.14%
p-value: p=0.002
Background We hypothesized that quantification of coronary atherosclerotic plaque burden by artificial intelligence-guided quantitative computed tomography can identify patients who derive outcome benefit from lipid-lowering medication (LLM).Methods In this observational cohort study, consecutive symptomatic patients undergoing coronary computed tomography angiography for suspected coronary artery disease (CAD) were assessed for percent atheroma volume (PAV) by artificial intelligence-guided quantitative computed tomography. The use of LLM was assessed based on drug purchase registry data within 6 months after coronary computed tomography angiography. Patients were followed for the composite of death, myocardial infarction, and unstable angina for a median of 6.9 years.Results Among 2269 patients (median age, 63 years; 42% men), 1261 (56%) patients used LLM after coronary computed tomography angiography, and 255 (11%) experienced the composite end point during follow-up. The median PAV was 6.6% among users and 1.4% among nonusers of LLM (P5% (annual event rate, 2.62% versus 4.14%; adjusted P=0.002), even in the absence of obstructive CAD, but not among the 1359 patients with PAV ≤5% (annual event rate, 0.94% versus 0.65%; adjusted P=0.717). An adjusted Cox regression analysis, including interaction between PAV and LLM, suggested a PAV threshold between 4% and 10% for gaining prognostic benefit from LLM.Conclusions In symptomatic patients with suspected CAD, LLM after coronary computed tomography angiography was associated with a lower rate of adverse events during long-term follow-up among those with PAV >5%, even in the absence of obstructive CAD. The quantification of coronary atherosclerotic plaque burden is a potential marker to guide preventive lipid-lowering therapy.
Maaniitty et al. (Mon,) conducted a cohort in Suspected coronary artery disease (CAD) (n=2,269). Lipid-lowering medication vs. No lipid-lowering medication was evaluated on Composite of death, myocardial infarction, and unstable angina (p=0.002). Lipid-lowering medication in patients with suspected CAD and percent atheroma volume >5% was associated with a lower annual rate of death, MI, or unstable angina (2.62% vs 4.14%; P=0.002).