Joshua Schulman-Marcus1, Bríain Ó Hartaigh2, Ashley E Giambrone3, Heidi Gransar4, Valentina Valenti2, Daniel S Berman4, Matthew J Budoff5, Stephan Achenbach6, Mouaz Al-Mallah7, Daniele Andreini8, Filippo Cademartiri9, Tracy Q Callister10, Hyuk-Jae Chang11, Kavitha Chinnaiyan12, Benjamin J W Chow13, Ricardo Cury14, Augustin Delago15, Martin Hadamitzky16, Joerg Hausleiter17, Gudrun Feuchtner18, Yong-Jin Kim19, Philipp A Kaufmann20, Jonathon Leipsic21, Fay Y Lin1, Erica Maffei22, Gianluca Pontone8, Gilbert Raff12, Leslee J Shaw23, Todd C Villines24, Allison Dunning25, James K Min26. 1. Department of Medicine, The NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA. 2. Department of Radiology, The NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA. 3. Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA. 4. Department of Imaging and Division of Cardiology, Department of Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA. 5. Department of Medicine, Harbor UCLA Medical Center, Los Angeles, CA, USA. 6. Department of Medicine, University of Erlangen, Erlangen, Germany. 7. Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, MI, USA. 8. Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy. 9. Cardio Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Italy; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands. 10. Tennessee Heart and Vascular Institute, Hendersonville, TN, USA. 11. Division of Cardiology, Severance Cardiovascular Hospital, Seoul, South Korea. 12. William Beaumont Hospital, Royal Oaks, MI, USA. 13. Department of Medicine and Radiology, University of Ottawa Heart Institute, ON, Canada. 14. Baptist Cardiac and Vascular Institute, Miami, FL, USA. 15. Capitol Cardiology Associates, Albany, NY, USA. 16. Division of Cardiology, DeutschesHerzzentrumMünchen, Munich, Germany. 17. Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany. 18. Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria. 19. Department of Medicine and Radiology, Seoul National University Hospital, Seoul, South Korea. 20. Department of Nuclear Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland. 21. Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada. 22. Cardio Vascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Italy. 23. Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA. 24. Department of Medicine, Walter Reed National Medical Center, Bethesda, MD, USA. 25. Duke Clinical Research Institute, Durham, NC, USA. 26. Department of Radiology, The NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA. Electronic address: jkm2001@med.cornell.edu.
Abstract
OBJECTIVE: This study sought to determine the correlation between baseline cardiac medications and cardiovascular outcomes in patients with obstructive coronary artery disease (CAD) diagnosed by coronary computed tomographic angiography (CCTA). METHODS: 1637 patients (mean age 64.8 ± 10.2 years, 69.6% male) with obstructive CAD from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry were followed over the course of three years. Obstructive CAD was defined as a ≥50% stenosis in an epicardial vessel. Medications analyzed included statins, aspirin, beta-blockers, angiotensin converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs). Using Cox proportional-hazards models, we calculated the hazard ratio (HR) with 95% confidence intervals (95% CIs) for incident major adverse cardiovascular events (MACE), defined as death, acute coronary syndrome, or myocardial infarction. RESULTS: At the time of CCTA, 59%, 54%, 40%, and 46% of patients were using statins, aspirin, beta-blockers, and ACE inhibitors or ARBs, respectively. Statins were associated with a 43% (95% CI = 0.38-0.87, p = 0.008) lower adjusted risk of MACE. Following adjustment, aspirin, beta-blockers, ACE inhibitors and ARBs did not attenuate the risk of MACE. When restricted to patients with multivessel obstructive CAD, only statins were associated with lower risk of MACE. CONCLUSION: In patients with obstructive CAD by CCTA, the baseline use of statins was associated with improved clinical outcomes. Other cardiac medications-including aspirin, beta-blockers, ACE inhibitors, and ARBs-were not associated with reduced risk of MACE.
OBJECTIVE: This study sought to determine the correlation between baseline cardiac medications and cardiovascular outcomes in patients with obstructive coronary artery disease (CAD) diagnosed by coronary computed tomographic angiography (CCTA). METHODS: 1637 patients (mean age 64.8 ± 10.2 years, 69.6% male) with obstructive CAD from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry were followed over the course of three years. Obstructive CAD was defined as a ≥50% stenosis in an epicardial vessel. Medications analyzed included statins, aspirin, beta-blockers, angiotensin converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs). Using Cox proportional-hazards models, we calculated the hazard ratio (HR) with 95% confidence intervals (95% CIs) for incident major adverse cardiovascular events (MACE), defined as death, acute coronary syndrome, or myocardial infarction. RESULTS: At the time of CCTA, 59%, 54%, 40%, and 46% of patients were using statins, aspirin, beta-blockers, and ACE inhibitors or ARBs, respectively. Statins were associated with a 43% (95% CI = 0.38-0.87, p = 0.008) lower adjusted risk of MACE. Following adjustment, aspirin, beta-blockers, ACE inhibitors and ARBs did not attenuate the risk of MACE. When restricted to patients with multivessel obstructive CAD, only statins were associated with lower risk of MACE. CONCLUSION: In patients with obstructive CAD by CCTA, the baseline use of statins was associated with improved clinical outcomes. Other cardiac medications-including aspirin, beta-blockers, ACE inhibitors, and ARBs-were not associated with reduced risk of MACE.
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