Usefulness of baseline statin therapy in non-obstructive coronary artery disease by coronary computed tomographic angiography: From the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) study

BackgroundThe extent to which the presence and extent of subclinical atherosclerosis by coronary computed tomography angiography influences a potential mortality benefit of statin is unknown. We evaluated the relationship between statin therapy, mortality, and subclinical atherosclerosis.MethodsIn the CONFIRM study, patients with normal or non-obstructive plaque (Results1.2% of patients experienced all-cause mortality. Patients not on baseline statin therapy had a stepwise increased risk of all-cause mortality by CAC (relative to CAC = 0; CAC 1–99: hazard ratio [HR] 1.65, CAC 100–299: HR 2.19, and CAC≥300: HR 2.98) or SIS (relative to SIS = 0; SIS 1: HR 1.62, SIS 2–3: 2.48 and SIS≥4: 2.95). Conversely, in patients on baseline statin therapy, there was no significant increase in mortality risk with increasing CAC (p value for interaction = 0.049) or SIS (p value for interaction = 0.007). The incidence of MACE was 2.1%. Similar to the all-cause mortality, the risk of MACE was increased with CAC or SIS strata in patient not on baseline statin therapy. However, this relation was not observed in patient on baseline statin therapy.ConclusionIn individuals with non-obstructive coronary artery disease, increased risk of adverse events occurs with increasing CAC or SIS who are not on baseline statin therapy. Statin therapy is associated with a mitigation of risk of cardiac events in the presence of increasing atherosclerosis, with no particular threshold of disease burden.背景 目前尚不明确通过冠状动脉计算机断层血管造影（coronary computed tomography angiography）检测到的亚临床动脉粥样硬化的存在与程度，对他汀类药物（statin）潜在的死亡率获益存在何种程度的影响。本研究旨在评估他汀类药物治疗、死亡率与亚临床动脉粥样硬化三者之间的关联。 方法 在CONFIRM研究中，纳入了存在正常或非阻塞性斑块的患者。 结果 1.2%的患者发生了全因死亡。未接受基线他汀类药物治疗的患者，其全因死亡风险随冠状动脉钙化评分（coronary artery calcium score, CAC）水平升高呈逐步升高趋势（以CAC=0为参照：CAC 1~99时，风险比[HR]为1.65；CAC 100~299时，HR为2.19；CAC≥300时，HR为2.98）；节段受累评分（segmental involvement score, SIS）升高也伴随全因死亡风险上升（以SIS=0为参照：SIS=1时，HR为1.62；SIS 2~3时，HR为2.48；SIS≥4时，HR为2.95）。与之相反，在接受基线他汀类药物治疗的患者中，随着CAC或SIS水平升高，其死亡风险并未出现显著升高（交互作用P值分别为0.049和0.007）。主要不良心血管事件（major adverse cardiovascular events, MACE）的发生率为2.1%。与全因死亡的趋势一致，未接受基线他汀类药物治疗的患者中，MACE风险随CAC或SIS分层升高而增加；但在接受基线他汀类药物治疗的患者中未观察到这一关联。 结论 对于存在非阻塞性冠状动脉疾病的个体，未接受基线他汀类药物治疗者，其不良事件风险随CAC或SIS水平升高而升高。在动脉粥样硬化负荷增加的情况下，他汀类药物治疗可降低心血管事件风险，且不存在特定的疾病负担阈值。