Department of Cardiology, Odense University Hospital, Odense, Esbjerg, Denmark; Department of Clinical Medicine, Health, University of Southern Denmark, Odense, Denmark.
Department of Cardiology, Odense University Hospital, Odense, Esbjerg, Denmark; Department of Clinical Medicine, Health, University of Southern Denmark, Odense, Denmark.
JACC Cardiovasc Imaging. 2021 Dec;14(12):2400-2410. doi: 10.1016/j.jcmg.2021.05.022. Epub 2021 Jul 14.
The aim of this work was to evaluate the prognostic impact of statin therapy in symptomatic patients without obstructive CAD.
Information on the prognostic impact of post-coronary computed tomographic angiography (CTA) statin use in patients with no or nonobstructive coronary artery disease (CAD) is sparse.
Patients undergoing CTA with suspected CAD in western Denmark from 2008 to 2017 with <50% coronary stenoses were identified. Information on post-CTA use of statin therapy and cardiovascular events were obtained from national registries.
The study included 33,552 patients, median aged 56 years, 58% female, with no (n = 19,669) or nonobstructive (n = 13,883) CAD and a median follow-up of 3.5 years. The absolute risk of the combined end point of myocardial infarction (MI) or all-cause mortality was directly associated with the CAD burden with an event rate/1,000 patient-years of 4.13 (95% CI: 3.69-4.61) in no, 7.74 (95% CI: 6.88-8.71) in mild (coronary artery calcium score [CACS] 0-99), 13.72 (95% CI: 11.61-16.23) in moderate (CACS 100-399), and 32.47 (95% CI: 26.25-40.16) in severe (CACS ≥400) nonobstructive CAD. Statin therapy was associated with a multivariable adjusted HR for MI and death of 0.52 (95% CI: 0.36-0.75) in no, 0.44 (95% CI: 0.32-0.62) in mild, 0.51 (95% CI: 0.34-0.75) in moderate, and 0.52 (95% CI: 0.32-0.86) in severe nonobstructive CAD. The estimated numbers needed to treat to prevent the primary end point were 92 (95% CI: 61-182) in no, 36 (95% CI: 26-58) in mild, 24 (95% CI: 15-61) in moderate, and 13 (95% CI: 7-86) in severe nonobstructive CAD. Residual confounding may persist, but not to an extent explaining all of the observed risk reduction associated with statin treatment.
The risk of MI and all-cause mortality in patients without obstructive CAD is directly associated with the CAD burden. Statin therapy is associated with a reduction of MI and all-cause death across the spectrum of CAD, however, the absolute benefit of treatment is directionally proportional with the CAD burden.
本研究旨在评估在无阻塞性 CAD 的有症状患者中他汀类药物治疗的预后影响。
关于在无或非阻塞性冠状动脉疾病（CAD）患者中，经冠状动脉 CT 血管造影（CTA）后使用他汀类药物的预后影响的信息较为匮乏。
在丹麦西部，我们确定了 2008 年至 2017 年间因疑似 CAD 而行 CTA 的患者，这些患者的冠状动脉狭窄程度<50%。我们从国家登记处获得了 CTA 后使用他汀类药物治疗和心血管事件的信息。
研究纳入了 33552 例患者，中位年龄为 56 岁，58%为女性，其中 19669 例患者无 CAD，13883 例患者存在非阻塞性 CAD，中位随访时间为 3.5 年。心肌梗死（MI）或全因死亡率的复合终点的绝对风险与 CAD 负担直接相关，无 CAD 患者的事件发生率/每 1000 例患者年为 4.13（95%CI：3.69-4.61），轻度 CAD（冠状动脉钙评分[CACS]0-99）患者为 7.74（95%CI：6.88-8.71），中度 CAD（CACS 100-399）患者为 13.72（95%CI：11.61-16.23），重度 CAD（CACS≥400）患者为 32.47（95%CI：26.25-40.16）。他汀类药物治疗与多变量调整后的 MI 和死亡风险比为 0.52（95%CI：0.36-0.75），无 CAD 患者为 0.44（95%CI：0.32-0.62），轻度 CAD 患者为 0.51（95%CI：0.34-0.75），中度 CAD 患者为 0.52（95%CI：0.32-0.86），重度 CAD 患者为 0.52（95%CI：0.32-0.86）。预防主要终点的估计需要治疗人数分别为无 CAD 患者 92（95%CI：61-182）、轻度 CAD 患者 36（95%CI：26-58）、中度 CAD 患者 24（95%CI：15-61）和重度 CAD 患者 13（95%CI：7-86）。可能存在残余混杂，但并未达到足以解释与他汀类药物治疗相关的所有观察到的风险降低的程度。
在无阻塞性 CAD 的患者中，MI 和全因死亡率的风险与 CAD 负担直接相关。他汀类药物治疗与 MI 和全因死亡的风险降低相关，但是治疗的绝对获益与 CAD 负担成正比。
