Coronary artery disease detected by coronary computed tomographic angiography is associated with intensifcation of preventive medical therapy and lower low-density lipoprotein cholesterol

Abstract

Background-Coronary computed tomographic angiography (CCTA) is an accurate test for the identifcation of coronary artery disease (CAD), yet the impact of CCTA results on subsequent medical therapy and risk factors has not been widely reported. Methods and Results-We identifed consecutive patients aged >18 years without prior CAD who underwent CCTA from 2004 to 2011 and had complete data on medications before and after CCTA. CCTA results were categorized as no CAD, <50% stenosis, and >50% stenosis. Based on the number of involved segments, extent of disease was categorized as nonextensive (<4 segments) or extensive CAD (>4 segments). Electronic medical records and patient interviews were reviewed blinded to CCTA fndings to assess initiation of aspirin and intensifcation of lipid-lowering therapies. Survival analysis was performed to evaluate intensifcation of lipid therapy as a predictor of cardiovascular death or nonfatal myocardial infarction. Among 2839 patients with mean follow-up of 3.6 years, the odds of physician intensifcation of lipid-lowering therapy signifcantly increased for those with nonobstructive CAD (odds ratio, 3.6; 95% confdence interval, 2.9-4.9; P<0.001) and obstructive CAD (odds ratio, 5.6; 95% confdence interval, 4.3-7.3; P<0.001). Low-density lipoprotein cholesterol levels declined signifcantly in association with intensifcation of lipid-lowering therapy after CCTA in all patient subgroups. In a hypothesis-generating analysis, among patients with nonobstructive but extensive CAD, statin use after CCTA was associated with a reduction in cardiovascular death or myocardial infarction (hazards ratio, 0.18; 95% confdence interval, 0.05-0.66; P=0.01). Conclusions-Abnormal CCTA fndings are associated with downstream intensifcation in statin and aspirin therapy. In particular, CCTA may lead to increased use of prognostically benefcial therapies in patients identifed as having extensive, nonobstructive CAD. © 2014 American Heart Association, Inc.