Edward Hulten1, Marcio Sommer Bittencourt1, Avinainder Singh1, Daniel O'Leary1, Mitalee P Christman1, Wafa Osmani1, Suhny Abbara1, Michael L Steigner1, Quynh A Truong1, Khurram Nasir1, Frank F Rybicki1, Josh Klein1, Jon Hainer1, Thomas J Brady1, Udo Hoffmann1, Brian B Ghoshhajra1, Rory Hachamovitch1, Marcelo F Di Carli1, Ron Blankstein2. 1. From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.); Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.); Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston; Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.); and Cleveland Clinic Foundation, OH (R.H.). 2. From the Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA (E.H., M.S.B., A.S., D.O., M.P.C., W.O., M.L.S., F.F.R., J.K., J.H., M.F.D.C., R.B.); Cardiology Service, Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD (E.H.); Center for Clinical and Epidemiological Research, Division of Internal Medicine, University of São Paulo, São Paulo, Brazil (M.S.B.); Cardiac MR PET CT Program, Department of Radiology, Division of Cardiac Imaging (S.A., T.J.B., U.H., B.B.G.), and Division of Cardiology (Q.A.T.), Massachusetts General Hospital, Harvard Medical School, Boston; Center for Wellness and Prevention Research, Baptist Health South Florida, Miami (K.N.); and Cleveland Clinic Foundation, OH (R.H.). rblankstein@partners.org.
Abstract
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, <50% stenosis, and ≥50% stenosis. Based on the number of involved segments, extent of disease was categorized as nonextensive (≤4 segments) or extensive 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.
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, <50% stenosis, and ≥50% stenosis. Based on the number of involved segments, extent of disease was categorized as nonextensive (≤4 segments) or extensive 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.
Authors: Amit Pursnani; Christopher L Schlett; Thomas Mayrhofer; Csilla Celeng; Pearl Zakroysky; Fabian Bamberg; John T Nagurney; Quynh A Truong; Udo Hoffmann Journal: J Cardiovasc Comput Tomogr Date: 2015-02-18
Authors: Michael K Cheezum; Prem Srinivas Subramaniyam; Marcio S Bittencourt; Edward A Hulten; Brian B Ghoshhajra; Nishant R Shah; Daniel E Forman; Jon Hainer; Marcia Leavitt; Ram Padmanabhan; Hicham Skali; Sharmila Dorbala; Udo Hoffmann; Suhny Abbara; Marcelo F Di Carli; Henry Gewirtz; Ron Blankstein Journal: Eur Heart J Cardiovasc Imaging Date: 2015-04-20 Impact factor: 6.875
Authors: S Divakaran; M K Cheezum; E A Hulten; M S Bittencourt; M G Silverman; K Nasir; R Blankstein Journal: Br J Radiol Date: 2014-12-12 Impact factor: 3.039