Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.
Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA.
J Cardiovasc Comput Tomogr. 2019 Mar-Apr;13(2):99-104. doi: 10.1016/j.jcct.2019.01.015. Epub 2019 Jan 29.
Non-statin therapy (NST) is used as second-line treatment when statin monotherapy is inadequate or poorly tolerated.
To determine the association of NST with plaque composition, alone or in combination with statins, in patients undergoing coronary computed tomography angiography (coronary CTA).
From the multicenter CONFIRM registry, we analyzed individuals who underwent coronary CTA with known lipid-lowering therapy status and without prior coronary artery disease at baseline. We created a propensity score for being on NST, followed by stepwise multivariate linear regression, adjusting for the propensity score as well as risk factors, to determine the association between NST and the number of coronary artery segments with each plaque type (non-calcified (NCP), partially calcified (PCP) or calcified (CP)) and segment stenosis score (SSS).
Of the 27,125 subjects in CONFIRM, 4,945 met the inclusion criteria; 371 (7.5%) took NST. At baseline, patients on NST had more prevalent risk factors and were more likely to be on concomitant cardiac medications. After multivariate and propensity score adjustment, NST was not associated with plaque composition: NCP (0.07 increase, 95% CI: -0.05, 0.20; p = 0.26), PCP (0.10 increase, 95% CI: -0.10, 0.31; p = 0.33), CP (0.18 increase, 95% CI: -0.10, 0.46; p = 0.21) or SSS (0.45 increase, 95% CI: -0.02,0.93; p = 0.06). The absence of an effect of NST on plaque type was not modified by statin use (p for interaction > 0.05 for all).
In this cross-sectional study, non-statin therapy was not associated with differences in plaque composition as assessed by coronary CTA.
当他汀类药物单药治疗效果不足或不耐受时，会使用非他汀类药物（NST）作为二线治疗。
确定单独使用或联合使用 NST 与斑块成分之间的关联，在接受冠状动脉计算机断层扫描血管造影（冠状动脉 CTA）的患者中。
我们从多中心 CONFIRM 登记处分析了接受冠状动脉 CTA 检查且已知降脂治疗情况且基线时无先前冠状动脉疾病的个体。我们创建了一个使用 NST 的倾向评分，然后进行逐步多元线性回归，根据倾向评分以及危险因素进行调整，以确定 NST 与每个斑块类型（非钙化斑块（NCP）、部分钙化斑块（PCP）或钙化斑块（CP））的冠状动脉节段数量以及节段狭窄评分（SSS）之间的关联。
在 CONFIRM 的 27125 名受试者中，有 4945 名符合纳入标准；其中 371 名（7.5%）服用 NST。在基线时，服用 NST 的患者有更多常见的危险因素，并且更有可能同时服用心脏药物。经过多元和倾向评分调整后，NST 与斑块成分无关：NCP（增加 0.07，95%CI：-0.05，0.20；p=0.26）、PCP（增加 0.10，95%CI：-0.10，0.31；p=0.33）、CP（增加 0.18，95%CI：-0.10，0.46；p=0.21）或 SSS（增加 0.45，95%CI：-0.02，0.93；p=0.06）。他汀类药物使用对斑块类型无影响（p 交互值>0.05）。
在这项横断面研究中，非他汀类药物治疗与冠状动脉 CTA 评估的斑块成分差异无关。
