Szilveszter Bálint, Vattay Borbála, Boussoussou Melinda, Nagy-Vecsey Milán, Rokszin György, Fábián Ibolya, Simon Judit, Merkely Béla, Maurovich-Horvat Pál, Kolossváry Márton
Semmelweis University, Heart and Vascular Centre, Budapest, Hungary.
Semmelweis University, Heart and Vascular Centre, Budapest, Hungary.
JACC Cardiovasc Imaging. 2025 Jul 21. doi: 10.1016/j.jcmg.2025.05.018.
Although statins are recommended for decreasing cardiovascular risk, their efficacy across different patient phenotypes stratified by coronary artery disease (CAD) remains unclear.
This study aims to evaluate whether statins decrease major adverse cardiac events (MACE) among CAD phenotypes according to severity, vulnerability and extent categorized by coronary computed tomography angiography (CTA).
The authors analyzed consecutive patients who were referred for coronary CTA at a tertiary center for the assessment of chronic coronary syndrome. The primary endpoint was MACE defined as a composite of all-cause mortality, acute myocardial infarction, or revascularization for unstable angina. Statin use was defined as annualized days on statin therapy (days on statin based on redeemed prescriptions, divided by follow-up time), and analyzed for each 10% increase in statin use over the follow-up period. Interaction analysis, adjusting for risk factors was applied to define treatment benefit across CAD phenotypes.
Overall, 11,026 individuals (mean age: 58.6 ± 11.9 years, 54.7% male) were analyzed who underwent coronary CTA between January 1, 2013, and December 31, 2020. A 10% increase in statin use was associated with lower risk for MACE the stratified Cox-regression model in patients with CAD (adjusted HR [aHR]: 0.95 [95% CI: 0.92-0.99]; P = 0.006), but not in patients without CAD (aHR: 0.95 [95% CI: 0.84-1.07]; P = 0.370). In the total population using interaction analysis including CAD phenotypes, a 10% increase in statin use decreased the risk for MACE in the presence of obstructive CAD (aHR: 0.91 [95% CI: 0.85-0.97]; P = 0.006), high-risk plaque (aHR: 0.82 [95% CI: 0.68-0.98]; P = 0.026), calcium score of ≥400 (aHR: 0.93 [95% CI: 0.87-0.99]; P = 0.024), and segment involvement score of >4 (aHR: 0.89 [95% CI: 0.84-0.95]; P < 0.001), but not for any CAD (aHR: 0.95 [95% CI: 0.85-1.07]; P = 0.411).
Statin efficacy to decrease MACE depends on CAD phenotypes and increases with the extent and severity of disease and in the presence of high-risk plaques. Patients without CAD have no benefit from statin therapy regarding MACE. Coronary CTA may play a pivotal role in optimizing statin allocation for personalized treatment decisions to prevent MACE.
尽管推荐使用他汀类药物来降低心血管疾病风险，但在根据冠状动脉疾病（CAD）分层的不同患者表型中，其疗效仍不明确。
本研究旨在评估他汀类药物是否能降低根据冠状动脉计算机断层扫描血管造影（CTA）分类的CAD表型中的主要不良心脏事件（MACE）。
作者分析了在一家三级中心因慢性冠状动脉综合征评估而接受冠状动脉CTA检查的连续患者。主要终点是MACE，定义为全因死亡率、急性心肌梗死或不稳定型心绞痛血运重建的综合指标。他汀类药物的使用定义为他汀类药物治疗的年化天数（基于已兑换处方的他汀类药物天数除以随访时间），并分析随访期间他汀类药物使用每增加10%的情况。应用调整风险因素的交互分析来确定不同CAD表型的治疗益处。
总体而言，分析了2013年1月1日至2020年12月31日期间接受冠状动脉CTA检查的11,026名个体（平均年龄：58.6±１1.9岁，54.7%为男性）。在CAD患者中，他汀类药物使用增加10%与分层Cox回归模型中MACE风险降低相关（调整后风险比[aHR]：0.95[95%置信区间（CI）：0.92 - 0.99]；P = 0.006），但在无CAD患者中无此关联（aHR：0.95[95% CI：0.84 - 1.07]；P = 0.370）。在包括CAD表型的总体人群中进行交互分析时，他汀类药物使用增加10%可降低存在阻塞性CAD（aHR：0.91[95% CI：0.85 - 0.97]；P = 0.006）、高危斑块（aHR：0.82[95% CI：0.68 - 0.98]；P = 0.026）、钙评分≥400（aHR：0.93[95% CI：0.87 - 0.99]；P = 0.024）和节段累及评分>4（aHR：0.89[95% CI：0.84 - 0.95]；P < 0.001）时的MACE风险，但对任何CAD情况均无此作用（aHR：0.95[95% CI：0.85 - 1.07]；P = 0.411）。
他汀类药物降低MACE的疗效取决于CAD表型，并随着疾病的范围和严重程度以及存在高危斑块而增加。无CAD的患者在MACE方面无法从他汀类药物治疗中获益。冠状动脉CTA可能在优化他汀类药物分配以做出个性化治疗决策以预防MACE方面发挥关键作用。
