Effects of cardiac medications for patients with obstructive coronary artery disease by coronary computed tomographic angiography: Results from the multicenter CONFIRM registry

• Published in: Atherosclerosis Vol. 238; no. 1; pp. 119 - 125
• Main Authors: Schulman-Marcus, Joshua, Hartaigh, Bríain ó, Giambrone, Ashley E., Gransar, Heidi, Valenti, Valentina, Berman, Daniel S., Budoff, Matthew J., Achenbach, Stephan, Al-Mallah, Mouaz, Andreini, Daniele, Cademartiri, Filippo, Callister, Tracy Q., Chang, Hyuk-Jae, Chinnaiyan, Kavitha, Chow, Benjamin J.W., Cury, Ricardo, Delago, Augustin, Hadamitzky, Martin, Hausleiter, Joerg, Feuchtner, Gudrun, Kim, Yong-Jin, Kaufmann, Philipp A., Leipsic, Jonathon, Lin, Fay Y., Maffei, Erica, Pontone, Gianluca, Raff, Gilbert, Shaw, Leslee J., Villines, Todd C., Dunning, Allison, Min, James K.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.01.2015
• Subjects: Aged; Algorithms; Cardiovascular; Cohort Studies; Coronary Angiography; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - drug therapy; Coronary computed tomographic angiography; Female; Heart - drug effects; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Major adverse cardiac events; Male; Medication therapy; Middle Aged; Proportional Hazards Models; Registries; Statins; Tomography, X-Ray Computed; Treatment Outcome; LcX; Major adverse cardiac events; LM; CAD; HR; Coronary artery disease; LAD; Coronary computed tomographic angiography; RCA; ACS; Medication therapy; CCTA; MACE; CONFIRM; Statins; COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter Registry; Left Main; right coronary artery; left anterior descending; left circumflex; hazard ratio; Acute coronary syndrome
• ISSN: 0021-9150; 1879-1484; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2014.11.007

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. •We analyzed medication use of patients with obstructive CAD diagnosed by CCTA.•Statins were significantly associated with lower risk of MACE.•Secondary prevention medications were not associated with reduced risk of MACE.•Findings were similar in patients with multivessel CAD.