Coronary Artery Disease Detected by Coronary Computed Tomographic Angiography Is Associated With Intensification of Preventive Medical Therapy and Lower Low-Density Lipoprotein Cholesterol

被引：91

作者：

Hulten, Edward ^{[1
,2
,3
,4
]}

Bittencourt, Marcio Sommer ^{[1
,2
,5
]}

Singh, Avinainder ^{[1
,2
]}

O'Leary, Daniel ^{[1
,2
]}

Christman, Mitalee P. ^{[1
,2
]}

Osmani, Wafa ^{[1
,2
]}

Abbara, Suhny ^{[6
]}

Steigner, Michael L. ^{[1
,2
]}

Truong, Quynh A. ^{[7
]}

Nasir, Khurram ^{[8
]}

Rybicki, Frank F. ^{[1
,2
]}

Klein, Josh ^{[1
,2
]}

Hainer, Jon ^{[1
,2
]}

Brady, Thomas J. ^{[6
]}

Hoffmann, Udo ^{[6
]}

Ghoshhajra, Brian B. ^{[6
]}

Hachamovitch, Rory ^{[9
]}

Di Carli, Marcelo F. ^{[1
,2
]}

Blankstein, Ron ^{[1
,2
]}

机构：

[1] Brigham & Womens Hosp, Noninvas Cardiovasc Imaging Program, Dept Med, Boston, MA 02115 USA

[2] Brigham & Womens Hosp, Noninvas Cardiovasc Imaging Program, Dept Radiol, Boston, MA 02115 USA

[3] Walter Reed Natl Mil Med Ctr, Serv Cardiol, Div Med, Bethesda, MD USA

[4] Uniformed Serv Univ Hlth Sci, Bethesda, MD 20814 USA

[5] Univ Sao Paulo, Ctr Clin & Epidemiol Res, Div Internal Med, Sao Paulo, Brazil

[6] Harvard Univ, Sch Med, Dept Radiol,Div Cardiac Imaing, Cardiac MR PET CT Program,Massachusetts Gen Hosp, Boston, MA 02115 USA

[7] Harvard Univ, Sch Med, Massachusetts Gen Hosp, Div Cardiol, Boston, MA USA

[8] Baptist Hlth South Florida, Ctr Wellness & Prevent Res, Miami, FL USA

[9] Cleveland Clin Fdn, Cleveland, OH USA

来源：

CIRCULATION-CARDIOVASCULAR IMAGING | 2014年 / 7卷 / 04期

关键词：

aspirin; prevention and control; prognosis; PROPENSITY SCORE; PROGNOSTIC VALUE; STATIN THERAPY; RISK-FACTORS; CALCIUM; PATIENT; IMPACT; ATHEROSCLEROSIS; METAANALYSIS; MANAGEMENT;

D O I：

10.1161/CIRCIMAGING.113.001564

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：629 / U99

页数：18

共 34 条

[1]

Abbara Suhny, 2009, J Cardiovasc Comput Tomogr, V3, P190, DOI 10.1016/j.jcct.2009.03.004

[2] QUANTIFICATION OF CORONARY-ARTERY CALCIUM USING ULTRAFAST COMPUTED-TOMOGRAPHY [J].