Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
Korean J Radiol. 2019 Jul;20(7):1156-1166. doi: 10.3348/kjr.2018.0016.
To analyze the cardiovascular outcome of statin medication in individuals retrospectively categorized on the basis of the 2013 American College of Cardiology and American Heart Association (ACC/AHA) guidelines risk assessment and to determine the additional prognostic value of coronary computed tomography angiography (CCTA) in assessing cardiovascular disease (CVD) risk in this group.
This retrospective study reviewed 4255 asymptomatic individuals who had undergone self-referred CCTA with a median follow-up period of 87 months. The primary endpoint was major adverse cardiac events (MACEs); these included cardiac death, nonfatal myocardial infarction, and unstable angina. Individuals recommended for statins according to the ACC/AHA guidelines were analyzed by their assessed risk.
MACE occurrence was significantly higher in the statin-recommended (SR) group with significant coronary artery disease (CAD) than in those with insignificant CAD ( < 0.001). In individuals with a normal coronary artery on CCTA, MACEs did not occur regardless of statin medication. In the SR group with significant CAD, there was no significant difference between statin users and non-users ( = 0.810). However, in cases with insignificant CAD, the event-free survival was significantly lower among statin users ( = 0.034). In patients recommended for moderate-intensity statins, the segment involvement score on CCTA was significantly associated with a higher risk of MACEs (hazard ratio 2.558; = 0.001).
CCTA might have a potential role in CVD risk stratification among asymptomatic statin candidates.
根据 2013 年美国心脏病学会/美国心脏协会（ACC/AHA）指南风险评估，对他汀类药物治疗的心血管结局进行回顾性分析，并确定冠状动脉计算机断层扫描血管造影（CCTA）在评估该人群心血管疾病（CVD）风险中的额外预后价值。
这项回顾性研究回顾了 4255 名无症状个体，他们接受了自行转诊的 CCTA，中位随访时间为 87 个月。主要终点是主要不良心脏事件（MACE）；包括心脏死亡、非致死性心肌梗死和不稳定型心绞痛。根据 ACC/AHA 指南建议使用他汀类药物的个体根据其评估风险进行分析。
在他汀类药物推荐（SR）组中，具有显著冠状动脉疾病（CAD）的患者发生 MACE 的风险明显高于具有非显著 CAD 的患者（<0.001）。在 CCTA 显示正常冠状动脉的个体中，无论是否使用他汀类药物，均未发生 MACE。在 SR 组中，具有显著 CAD 的患者中，他汀类药物使用者和非使用者之间无显著差异（=0.810）。然而，在 CAD 不显著的情况下，他汀类药物使用者的无事件生存率明显较低（=0.034）。在建议使用中等强度他汀类药物的患者中，CCTA 的节段受累评分与更高的 MACE 风险显著相关（风险比 2.558；=0.001）。
CCTA 可能在无症状他汀类药物候选者的 CVD 风险分层中具有潜在作用。
