Abstract 15904: Assessment of Coronary Artery Disease Severity by Coronary Computed Tomography Angiography for Reclassifying Statin Eligibility Based on 2013 American College of Cardiology/American Heart Association Guidelines in Asymptomatic Individual
Introduction: The 2013 ACC/AHA cholesterol management guidelines advocate the use of statin treatment for prevention of CVD. We aimed to determine the usefulness of coronary computed tomographic angiography (CCTA) for risk stratification over statin eligibility among asymptomatic individuals.
Methods: From a 12-center international registry, we identified 608 statin naive asymptomatic patients (mean age 60±9, 70% male) without known CAD. Individuals were categorized by statin eligibility according to 2013 ACC/AHA guidelines. CAD severity assessed by CCTA was graded as none (0%), non-obstructive (1-49%), and obstructive (>50%) CAD. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause death, non-fatal MI, or late revascularization. Cox regression analysis was used to estimate hazard ratios (HR) with 95% confidential intervals (CI) across CAD severity. Category-free net reclassification (cNRI) was used to assess reclassification of CCTA when added to statin eligibility.
Results: 328 (54%) patients were classified as statin eligibility group by current guideline. Over a median 5.3 years (range: 4.9-5.9), 63 (10.4%) MACE occurred. Kaplan-Meier survival curves revealed increasing CAD severity was associated with a concurrent rise in MACE in both statin indicated and statin not indicated groups (Figure, PLog rank <0.01, both). After adjustment, there was a strong relationship between increased MACE risk and CAD severity in patients with statin indicated (HR: 5.49; 95% CI, 1.62-18.61, P =0.006). Further, CCTA improved reclassification of MACE beyond statin groups only (cNRI: 0.57, P <0.001)
Conclusions: CAD severity by CCTA augments reclassification of statin treatment according to 2013 ACC/AHA guidelines. Assessment of CAD severity may prove useful for guiding treatment decision-making for initiating statin therapy.
Author Disclosures: D. Han: None. B. ó Hartaigh: None. H. Gransar: None. J. Lee: None. A. Rizvi: None. L. Baskaran: None. J. Schulman-Marcus: None. P. Kaufmann: None. B. Chow: None. G. Raff: None. K. Chinnaiyan: None. F. Cademartiri: None. E. Maffei: None. T. Villines: None. Y. Kim: None. J. Leipsic: None. G. Feuchtner: None. R. Cury: None. G. Pontone: None. D. Andreini: None. T. Callister: None. H. Marques: None. R. Rubinshtein: None. A. DeLago: None. D. Berman: None. S. Achenbach: None. L. Shaw: None. M. Hadamitzky: None. J. Hausleiter: None. A. Dunning: None. M. Al-Mallah: None. M. Budoff: None. F.Y. Lin: None. H. Chang: None. J.K. Min: None.
- © 2016 by American Heart Association, Inc.