Elsemiek M Engbers1, Jorik R Timmer2, Mohamed Mouden3, Siert Knollema4, Pieter L Jager5, Jan Paul Ottervanger6. 1. Department of Cardiology, Isala, Zwolle, the Netherlands; Department of Nuclear Medicine, Isala, Zwolle, the Netherlands. Electronic address: e.engbers@isala.nl. 2. Department of Cardiology, Isala, Zwolle, the Netherlands. Electronic address: v.r.c.derks@isala.nl. 3. Department of Cardiology, Isala, Zwolle, the Netherlands; Department of Nuclear Medicine, Isala, Zwolle, the Netherlands. Electronic address: m.mouden@isala.nl. 4. Department of Nuclear Medicine, Isala, Zwolle, the Netherlands. Electronic address: s.knollema@isala.nl. 5. Department of Nuclear Medicine, Isala, Zwolle, the Netherlands. Electronic address: p.l.jager@isala.nl. 6. Department of Cardiology, Isala, Zwolle, the Netherlands. Electronic address: j.p.ottervanger@isala.nl.
Abstract
The impact of coronary artery calcium (CAC) scoring on subsequent changes in cardiovascular medication use in symptomatic patients with normal myocardial perfusion imaging (MPI) findings is not well established. The aim of the current study was to evaluate changes in aspirin and statin use in patients suspected for coronary artery disease after CAC scoring and normal single photon emission computed tomography (SPECT) MPI. METHODS: In the current study, 1,033 stable symptomatic patients without a known history of coronary artery disease with normal SPECT MPI who underwent concomitant CAC scoring were included. All patients had a clinical indication for imaging, mainly atypical chest pain and dyspnea, and were referred from the outpatient clinic of our hospital. Data regarding posttest medication change (either starting or discontinuation of aspirin and statin therapy at the subsequent outpatient visit) were retrospectively collected. Patients were categorized into 4 groups based on their CAC score. RESULTS: Mean age of the patients was 61±11 years and 39% were male. At baseline, 35% of the patients used aspirin and 39% used statin. In patients with CAC scores 0, 1-99, 100-399, and ≥400, aspirin was started in 1%, 4%, 9%, and 9%, respectively, and statin was started in 0%, 7%, 18%, and 24% of the patients, respectively (P<.001). Aspirin was discontinued in 19%, 11%, 7%, and 1% and statin was discontinued in 8%, 6%, 2%, and 0% (P<.001) of the patients in these respective CAC score categories. After correction for differences in risk factors and baseline medication use, increased CAC was independently associated with posttest aspirin (odds ratio 4.6, 11.2, and 27.1 for CAC scores 1-99, 100-399, and ≥400, respectively; P<.001) and statin use (odds ratio 4.4, 19.4, and 60.9 for CAC scores 1-99, 100-399, and ≥400, respectively; P<.001). CONCLUSIONS: Higher CAC scores are associated with the initiation of aspirin and statin therapy in patients with normal SPECT MPI. In patients with lower CAC scores, discontinuation of cardioprotective medication is more likely. CAC score is independently associated with posttest statin and aspirin use.
The impact of coronary artery calcium (CAC) scoring on subsequent changes in cardiovascular medication use in symptomatic patients with normal myocardial perfusion imaging (MPI) findings is not well established. The aim of the current study was to evaluate changes in aspirin and statin use in patients suspected for coronary artery disease after CAC scoring and normal single photon emission computed tomography (SPECT) MPI. METHODS: In the current study, 1,033 stable symptomatic patients without a known history of coronary artery disease with normal SPECT MPI who underwent concomitant CAC scoring were included. All patients had a clinical indication for imaging, mainly atypical chest pain and dyspnea, and were referred from the outpatient clinic of our hospital. Data regarding posttest medication change (either starting or discontinuation of aspirin and statin therapy at the subsequent outpatient visit) were retrospectively collected. Patients were categorized into 4 groups based on their CAC score. RESULTS: Mean age of the patients was 61±11 years and 39% were male. At baseline, 35% of the patients used aspirin and 39% used statin. In patients with CAC scores 0, 1-99, 100-399, and ≥400, aspirin was started in 1%, 4%, 9%, and 9%, respectively, and statin was started in 0%, 7%, 18%, and 24% of the patients, respectively (P<.001). Aspirin was discontinued in 19%, 11%, 7%, and 1% and statin was discontinued in 8%, 6%, 2%, and 0% (P<.001) of the patients in these respective CAC score categories. After correction for differences in risk factors and baseline medication use, increased CAC was independently associated with posttest aspirin (odds ratio 4.6, 11.2, and 27.1 for CAC scores 1-99, 100-399, and ≥400, respectively; P<.001) and statin use (odds ratio 4.4, 19.4, and 60.9 for CAC scores 1-99, 100-399, and ≥400, respectively; P<.001). CONCLUSIONS: Higher CAC scores are associated with the initiation of aspirin and statin therapy in patients with normal SPECT MPI. In patients with lower CAC scores, discontinuation of cardioprotective medication is more likely. CAC score is independently associated with posttest statin and aspirin use.
Authors: Konrad Pieszko; Aakash D Shanbhag; Mark Lemley; Mark Hyun; Serge Van Kriekinge; Yuka Otaki; Joanna X Liang; Daniel S Berman; Damini Dey; Piotr J Slomka Journal: Eur J Nucl Med Mol Imaging Date: 2022-06-25 Impact factor: 10.057
Authors: Wanda Y Wu; David W Biery; Adam N Berman; Grace Hsieh; Sanjay Divakaran; Sumit Gupta; Michael L Steigner; Ayaz Aghayev; Hicham Skali; Donna M Polk; Jorge Plutzky; Christopher P Cannon; Marcelo F Di Carli; Ron Blankstein Journal: J Cardiovasc Comput Tomogr Date: 2021-12-17