Changes in use of preventive medications after assessment of chest pain by coronary computed tomography angiography: A meta-analysis

Abstract

Background: Coronary computed tomography angiogram (CCTA) is a crucial tool for diagnosing CAD, but its impact on altering preventive medications is not well-documented. This systematic review aimed to compare changes in aspirin and statin therapy following CCTA and functional stress testing in patients with suspected CAD, and in those underwent CCTA when stratified by the presence/absence of plaque.

Results: Eight studies involving 42,812 CCTA patients and 64,118 cardiac stress testing patients were analyzed. Compared to functional testing, CCTA led to 66 ​% more changes in statin therapy (pooled RR, 95 ​% CI [1.28-2.15]) and a 74 ​% increase in aspirin prescriptions (pooled RR, 95 ​% CI [1.34-2.26]). For medication modifications based on CCTA results, 13 studies (47,112 patients with statin data) and 11 studies (12,089 patients with aspirin data) were included. Patients with any plaque on CCTA were five times more likely to use or intensify statins compared to those without CAD (pooled RR, 5.40, 95 ​% CI [4.16-7.00]). Significant heterogeneity remained, which decreased when stratified by diabetes rates. Aspirin use increased eightfold after plaque detection (pooled RR, 8.94 [95 ​% CI, 4.21-19.01]), especially with obstructive plaque findings (pooled RR, 9.41, 95 ​% CI [2.80-39.02]).

Conclusion: In conclusion, CCTA resulted in higher changes in statin and aspirin therapy compared to cardiac stress testing. Detection of plaque by CCTA significantly increased statin and aspirin therapy.

Keywords: Aspirin; Cardiac stress testing; Chest pain; Coronary computed tomography angiogram; Statin.