Abnormal CCTA findings were associated with increased odds of intensifying lipid-lowering therapy for both nonobstructive (OR 3.6; 95% CI 2.9-4.9) and obstructive CAD (OR 5.6; 95% CI 4.3-7.3).
Cohort (n=2,839)
Blinded outcome assessment
Does the detection of CAD by CCTA increase the intensification of preventive medical therapy in patients without prior CAD?
Abnormal CCTA findings are associated with downstream intensification of statin and aspirin therapy, which may reduce cardiovascular events in patients with extensive, nonobstructive CAD.
Odds Ratio: 3.6 (95% CI 2.9–4.9)
p-value: p=<0.001
BACKGROUND: Coronary computed tomographic angiography (CCTA) is an accurate test for the identification of coronary artery disease (CAD), yet the impact of CCTA results on subsequent medical therapy and risk factors has not been widely reported. METHODS AND RESULTS: We identified consecutive patients aged >18 years without prior CAD who underwent CCTA from 2004 to 2011 and had complete data on medications before and after CCTA. CCTA results were categorized as no CAD, 4 segments). Electronic medical records and patient interviews were reviewed blinded to CCTA findings to assess initiation of aspirin and intensification of lipid-lowering therapies. Survival analysis was performed to evaluate intensification of lipid therapy as a predictor of cardiovascular death or nonfatal myocardial infarction. Among 2839 patients with mean follow-up of 3.6 years, the odds of physician intensification of lipid-lowering therapy significantly increased for those with nonobstructive CAD (odds ratio, 3.6; 95% confidence interval, 2.9-4.9; P<0.001) and obstructive CAD (odds ratio, 5.6; 95% confidence interval, 4.3-7.3; P<0.001). Low-density lipoprotein cholesterol levels declined significantly in association with intensification of lipid-lowering therapy after CCTA in all patient subgroups. In a hypothesis-generating analysis, among patients with nonobstructive but extensive CAD, statin use after CCTA was associated with a reduction in cardiovascular death or myocardial infarction (hazards ratio, 0.18; 95% confidence interval, 0.05-0.66; P=0.01). CONCLUSIONS: Abnormal CCTA findings are associated with downstream intensification in statin and aspirin therapy. In particular, CCTA may lead to increased use of prognostically beneficial therapies in patients identified as having extensive, nonobstructive CAD.
Hulten et al. (Sat,) conducted a cohort in Coronary artery disease (n=2,839). Abnormal CCTA findings (nonobstructive or obstructive CAD) vs. No CAD on CCTA was evaluated on Physician intensification of lipid-lowering therapy (OR 3.6, 95% CI 2.9-4.9, p=<0.001). Abnormal CCTA findings were associated with increased odds of intensifying lipid-lowering therapy for both nonobstructive (OR 3.6; 95% CI 2.9-4.9) and obstructive CAD (OR 5.6; 95% CI 4.3-7.3).