European Radiology

, Volume 23, Issue 11, pp 2954–2960

Statin therapy in patients with atypical chest pain and mild-to-moderate coronary stenosis on 64-slice multidetector coronary computed tomography; a retrospective propensity score matching analysis

  • Hyo Eun Park
  • Goo-Yeong Cho
  • Yeonyee E. Yoon
  • Tae-Jin Youn
  • Eun-Ju Chun
  • Sang-Il Choi
  • Dong-Ju Choi
Cardiac

Abstract

Background

The effect of computed tomography (CT)-guided statin therapy on patients with atypical chest pain and mild-to-moderate coronary artery disease has not been elucidated yet.

Methods

A total of 1,952 patients who had 1-69 % stenosis on CT were reviewed retrospectively. After propensity score matching, 643 patients who were prescribed statins after CT (statin users) and 643 patients without statin therapy (statin non-users) were compared. Major cardiovascular events included all-cause death, acute coronary syndrome and stroke.

Results

During a median of 42 months’ follow-up, all-cause death was reported in 17 patients (1.3 %), of whom 6 (0.9 %) were statin users and 11 (1.7 %) statin nonusers. Major cardiovascular events developed in 6.1 % in the statin user group and 5.6 % in the statin non-users (P = 0.812). When evaluated according to plaque subtypes, statins showed significant benefit in patients who had non-calcified or mixed plaque (HR 0.47, 95 % CI 0.22-1.01, P = 0.047). However, in patients with calcified plaques, statins had no benefit in reducing adverse events (P = 0.620).

Conclusion

In most patients with mild-to-moderate coronary artery stenosis on CT, statin therapy has no beneficial effect on reducing adverse events. However, in patients with non-calcified or mixed plaques, statin therapy showed a significant benefit.

Key Points

Multidetector CT now identifies numerous subjects with mild-to-moderate coronary stenosis.

Statin therapy has little beneficial effect on patients with calcified plaques.

However, statins reduce adverse events in those with non-calcified or mixed plaques.

Keywords

Statin Cardiovascular outcome Computed tomography Coronary artery stenosis Angina pectoris 

References

  1. 1.
    Grundy SM, Cleeman JI, Merz CN et al (2004) Implications of recent clinical trials for the national cholesterol education program adult treatment panel III guidelines. Circulation 110:227–239PubMedCrossRefGoogle Scholar
  2. 2.
    De Backer G, Ambrosioni E, Borch-Johnsen K et al (2003) European guidelines on cardiovascular disease prevention in clinical practice. Third joint task force of European and other societies on cardiovascular disease prevention in clinical practice. Eur Heart J 24:1601–1610PubMedCrossRefGoogle Scholar
  3. 3.
    (1994) Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: The Scandinavian Simvastatin Survival Study (4s). Lancet 344:1383–1389Google Scholar
  4. 4.
    Shepherd J, Cobbe SM, Ford I et al (1995) Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med 333:1301–1307PubMedCrossRefGoogle Scholar
  5. 5.
    Sacks FM, Pfeffer MA, Moye LA et al (1996) The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and recurrent events trial investigators. N Engl J Med 335:1001–1009PubMedCrossRefGoogle Scholar
  6. 6.
    Downs JR, Clearfield M, Weis S et al (1998) Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA 279:1615–1622PubMedCrossRefGoogle Scholar
  7. 7.
    (1998) Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) study group. N Engl J Med 339:1349–1357Google Scholar
  8. 8.
    Sever PS, Dahlof B, Poulter NR et al (2003) Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet 361:1149–1158PubMedCrossRefGoogle Scholar
  9. 9.
    Ridker PM, Danielson E, Fonseca FA et al (2008) Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med 359:2195–2207PubMedCrossRefGoogle Scholar
  10. 10.
    Baigent C, Blackwell L, Emberson J et al (2010) Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 376:1670–1681PubMedCrossRefGoogle Scholar
  11. 11.
    Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832PubMedCrossRefGoogle Scholar
  12. 12.
    Leber AW, Becker A, Knez A et al (2006) Accuracy of 64-slice computed tomography to calssify and quantify plaque volumes in the proximal coronary system: a comparative study using intravascular ultrasound. J Am Coll Cardiol 47:672–677PubMedCrossRefGoogle Scholar
  13. 13.
    Achenbach S, Ropers D, Pohle K et al (2002) Influence of lipid-lowering therapy on the progression of coronary artery calcification: a prospective evaluation. Circulation 106:1077–1082PubMedCrossRefGoogle Scholar
  14. 14.
    Callister TQ, Raggi P, Cooil B, Lippolis NJ, Russo DJ (1998) Effect of HMG-CoA reductase inhibitors on coronary artery disease as assessed by electron-beam computed tomography. N Engl J Med 339:1972–1978PubMedCrossRefGoogle Scholar
  15. 15.
    Budoff MJ (2004) Tracking progression of heart disease with cardiac computed tomography. J Cardiovasc Pharmacol Ther 9:75–82PubMedCrossRefGoogle Scholar
  16. 16.
    Arad Y, Spadaro LA, Roth M, Newstein D, Guerci AD (2005) Treatment of asymptomatic adults with elevated coronary calcium scores with atorvastatin, vitamin C, and vitamin E: the St. Francis Heart Study randomized clinical trial. J Am Coll Cardiol 46:166–172PubMedCrossRefGoogle Scholar
  17. 17.
    Nicholls SJ, Tuzcu EM, Wolski K et al (2007) Coronary artery calcification and changes in atheroma burden in response to established medical therapies. J Am Coll Cardiol 49:263–270PubMedCrossRefGoogle Scholar
  18. 18.
    Nakazato R, Grensar H, Berman DS et al (2012) Statins use and coronary artery plaque composition: results from the International Multicenter CONFIRM Registry. Atherosclerosis 225:148–153PubMedCrossRefGoogle Scholar
  19. 19.
    Schmermund A, Achenbach S, Budde T et al (2006) Effect of intensive versus standard lipid-lowering treatment with atorvastatin on the progression of calcified coronary atherosclerosis over 12 months: a multicenter, randomized, double-blind trial. Circulation 113:427–437PubMedCrossRefGoogle Scholar
  20. 20.
    Inoue K, Motoyama S, Sarai M et al (2010) Serial coronary CT angiography-verified changes in plaque characteristics as an end point: evaluation of effect of statin intervention. JACC Cardiovasc Imaging 3:691–698PubMedCrossRefGoogle Scholar
  21. 21.
    Hoffmann H, Frieler K, Schlattmann P, Hamm B, Dewey M (2010) Influence of statin treatment on coronary atherosclerosis visualised using multidetector computed tomography. Eur Radiol 20:2824–2833PubMedCrossRefGoogle Scholar
  22. 22.
    Baigent C, Keech A, Kearney PM et al (2005) Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 366:1267–1278PubMedCrossRefGoogle Scholar
  23. 23.
    Wanahita N, Chen J, Bangalore S et al (2012) The effect of statin therapy on ventricular tachyarrhythmias: a meta-analysis. Am J Ther 19:16–23PubMedCrossRefGoogle Scholar
  24. 24.
    Serruys PW, de Feyter P, Macaya C et al (2002) Fluvastatin for prevention of cardiac events following successful first percutaneous coronary intervention: a randomized controlled trial. JAMA 287:3215–3222PubMedCrossRefGoogle Scholar
  25. 25.
    de Lemos JA, Blazing MA, Wiviott SD et al (2004) Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes: phase z of the a to z trial. JAMA 292:1307–1316PubMedCrossRefGoogle Scholar
  26. 26.
    Cannon CP, Braunwald E, McCabe CH et al (2004) Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 350:1495–1504PubMedCrossRefGoogle Scholar
  27. 27.
    LaRosa JC, Grundy SM, Waters DD et al (2005) Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med 352:1425–1435PubMedCrossRefGoogle Scholar
  28. 28.
    Nozue T, Yamamoto S, Tohyama S et al (2012) Comparison of arterial remodeling and changes in plaque composition between patients with progression versus regression of coronary atherosclerosis during statin therapy (from the TRUTH study). Am J Cardiol 109:1247–1253PubMedCrossRefGoogle Scholar
  29. 29.
    Houslay ES, Cowell SJ, Prescott RJ et al (2006) Progressive coronary calcification despite intensive lipid-lowering treatment: a randomized controlled trial. Heart 92:1207–1212PubMedCrossRefGoogle Scholar
  30. 30.
    Takano M, Mizuno K, Yokoyama S et al (2003) Changes in coronary plaque color and morphology by lipid-lowering therapy with atorvastatin: serial evaluation by coronary angioscopy. J Am Coll Cardiol 4:680–686CrossRefGoogle Scholar
  31. 31.
    Eto M, Kozai T, Consentino F, Joch H, Luscher TF (2002) Statin prevents tissue factor expression in human endothelial cells: role of Rho/Rho-kinase and Akt pathways. Circulation 105:1756–1759PubMedCrossRefGoogle Scholar
  32. 32.
    Kawasaki M, Takatsu H, Noda T et al (2002) In vivo quantitative tissue characterization of human coronary arterial plaques by use of integrated backscatter intravascular ultrasound and comparison with angioscopic findings. Circulation 105:2487–2492PubMedCrossRefGoogle Scholar
  33. 33.
    Taylor AJ, Cerqueira M, Hodgson JM et al (2010) ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation appropriate use criteria task force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. Circulation 122:e525–e555PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Hyo Eun Park
    • 1
  • Goo-Yeong Cho
    • 2
    • 4
  • Yeonyee E. Yoon
    • 2
  • Tae-Jin Youn
    • 2
  • Eun-Ju Chun
    • 3
  • Sang-Il Choi
    • 3
  • Dong-Ju Choi
    • 2
  1. 1.Healthcare System Gangnam CenterSeoul National University HospitalSeoulSouth Korea
  2. 2.Division of CardiologySeoul National University Bundang HospitalSeongnamSouth Korea
  3. 3.Division of RadiologySeoul National University Bundang HospitalSeongnamSouth Korea
  4. 4.Division of Cardiology, Department of Internal MedicineSeoul National University College of Medicine, Seoul National University Bundang HospitalSeongnam-siKorea

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