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Observational Study
. 2015 Jan;238(1):119-25.
doi: 10.1016/j.atherosclerosis.2014.11.007. Epub 2014 Nov 14.

Effects of cardiac medications for patients with obstructive coronary artery disease by coronary computed tomographic angiography: results from the multicenter CONFIRM registry

Joshua Schulman-Marcus  1 , Bríain Ó Hartaigh  2 , Ashley E Giambrone  3 , Heidi Gransar  4 , Valentina Valenti  2 , Daniel S Berman  4 , Matthew J Budoff  5 , Stephan Achenbach  6 , Mouaz Al-Mallah  7 , Daniele Andreini  8 , Filippo Cademartiri  9 , Tracy Q Callister  10 , Hyuk-Jae Chang  11 , Kavitha Chinnaiyan  12 , Benjamin J W Chow  13 , Ricardo Cury  14 , Augustin Delago  15 , Martin Hadamitzky  16 , Joerg Hausleiter  17 , Gudrun Feuchtner  18 , Yong-Jin Kim  19 , Philipp A Kaufmann  20 , Jonathon Leipsic  21 , Fay Y Lin  1 , Erica Maffei  22 , Gianluca Pontone  8 , Gilbert Raff  12 , Leslee J Shaw  23 , Todd C Villines  24 , Allison Dunning  25 , James K Min  26
Affiliations
Observational Study

Effects of cardiac medications for patients with obstructive coronary artery disease by coronary computed tomographic angiography: results from the multicenter CONFIRM registry

Joshua Schulman-Marcus et al. Atherosclerosis. 2015 Jan.

Abstract

Objective: This study sought to determine the correlation between baseline cardiac medications and cardiovascular outcomes in patients with obstructive coronary artery disease (CAD) diagnosed by coronary computed tomographic angiography (CCTA).

Methods: 1637 patients (mean age 64.8 ± 10.2 years, 69.6% male) with obstructive CAD from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) registry were followed over the course of three years. Obstructive CAD was defined as a ≥50% stenosis in an epicardial vessel. Medications analyzed included statins, aspirin, beta-blockers, angiotensin converting enzyme (ACE) inhibitors, and angiotensin receptor blockers (ARBs). Using Cox proportional-hazards models, we calculated the hazard ratio (HR) with 95% confidence intervals (95% CIs) for incident major adverse cardiovascular events (MACE), defined as death, acute coronary syndrome, or myocardial infarction.

Results: At the time of CCTA, 59%, 54%, 40%, and 46% of patients were using statins, aspirin, beta-blockers, and ACE inhibitors or ARBs, respectively. Statins were associated with a 43% (95% CI = 0.38-0.87, p = 0.008) lower adjusted risk of MACE. Following adjustment, aspirin, beta-blockers, ACE inhibitors and ARBs did not attenuate the risk of MACE. When restricted to patients with multivessel obstructive CAD, only statins were associated with lower risk of MACE.

Conclusion: In patients with obstructive CAD by CCTA, the baseline use of statins was associated with improved clinical outcomes. Other cardiac medications-including aspirin, beta-blockers, ACE inhibitors, and ARBs-were not associated with reduced risk of MACE.

Keywords: Coronary artery disease; Coronary computed tomographic angiography; Major adverse cardiac events; Medication therapy; Statins.

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Figures

Figure 1
Figure 1. Unadjusted 3-Year Survival by the Use of Selected Medications Survival curves for statins, aspirin, beta-blockers, ACE inhibitors/ARBs
Presence of medication may also include other medications
Figure 2
Figure 2
Unadjusted Survival by Primary versus Secondary Medication Regimen
See this image and copyright information in PMC

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