Abstract 13739: Potential Benefit of Statin Therapy in Patients with Non-Obstructive Coronary Artery Disease
Background: Recent analyses have challenged the benefit of statin and aspirin therapy for primary prevention in patients at high cardiovascular risk. Equally uncertain is the optimal therapy for patients with non-obstructive coronary atherosclerosis diagnosed using coronary computed tomographic angiography (CCTA). The objective of this study was to analyze the potential mortality benefit associated with statin and aspirin therapy in patients diagnosed of non-obstructive CAD.
Methods: 27,125 consecutive patients underwent CCTA at 12 enrolling centres (CONFIRM Registry). Patients with a history of myocardial infarction, obstructive CAD (≥50%) or coronary revascularization were excluded. Also excluded were patients lacking statin or aspirin information. Patients were allocated to statin and aspirin use if they were taking the respective medications at the time of CCTA. Patient were followed for all-cause mortality.
Results: A total of 10,418 patients (5712 normal and 4706 non-obstructive CAD) met the enrolment criteria. Mean follow-up duration was 29.0+/−14.6 months. Patients with non-obstructive CAD were older, more frequently male and had more cardiac risk factors. Statin and aspirin therapy was more common in patients with non-obstructive CAD than in patients without any plaque (statin: 43.2% versus 25.1% (p<0.001) and aspirin: 46.2% versus 30.8% (p<0.001), respectively). Statin use at the time of CCTA was associated with lower mortality (0.76% versus 1.34%; p<0.05) but aspirin therapy was not associated with any benefit. A multivariable Cox model confirmed that statin therapy was associated with lower mortality in the entire cohort of patients (0.52 (OR:0.34-0.79); p=0.002). Benefit of statin therapy was seen only in patients with non-obstructive CAD (OR:0.39 (0.24-0.65); p<0.001) and not observed in patients with normal coronary arteries (OR:0.65(0.31-1.37); p=0.258).
Conclusion: Statin therapy, but not use of aspirin, was associated with survival benefit in patients with non-obstructive CAD detected by CCTA. No benefit was seen in patients without coronary atherosclerotic plaque. Randomized controlled trials examining the potential benefit of statin therapy in patients with non-obstructive CAD are needed.
- © 2011 by American Heart Association, Inc.