ArticlePloS one2018
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.
Article in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01443637 (COronary CT Angiography Evaluation For Clinical Outcomes), which is not on this map. Cited by 12 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
COronary CT Angiography Evaluation For Clinical Outcomes: An International Multicenter Registry
Who cites it
12 citing papers in PubMed, 27 citations in OpenAlex.
- Impact of coronary CT angiography in selection of treatment modalities and subsequent cardiovascular events in Thai patients with stable CAD.Clinical research in cardiology : official journal of the German Cardiac Society · 2024Trial
- Quantitative Coronary Atherosclerotic Plaque Burden From CCTA and the Benefit From Lipid-Lowering Medication.Circulation. Cardiovascular imaging · 2026Observational
- Review
- Prognostic Value of Serial Coronary CT Angiography in Atherosclerotic Plaque Modification: What have we learnt?Current cardiovascular imaging reports · 2022Article
- Japanese multicenter registry evaluating the antegrade dissection reentry with cardiac computerized tomography for chronic coronary total occlusion.Cardiovascular intervention and therapeutics · 2022Article
- Risk Stratification With the Use of Coronary Computed Tomographic Angiography in Patients With Nonobstructive Coronary Artery Disease.JACC. Cardiovascular imaging · 2021 · on this mapArticle
- Coronary CT Angiography Guided Medical Therapy in Subclinical Atherosclerosis.Journal of clinical medicine · 2021Review
- The association between carotid calcium on dental panoramic radiographs and coronary calcium score on chest computerized tomography.Dento maxillo facial radiology · 2021Article
- Ten-year cardiovascular risk in diabetes patients without obstructive coronary artery disease: a retrospective Western Denmark cohort study.Cardiovascular diabetology · 2021Observational
- Updated diagnostic & prognostic paradigm for CAD: a narrative review.Cardiovascular diagnosis and therapy · 2020Review
- Guideline-Based Statin Eligibility, Coronary Artery Stenosis and Cardiovascular Events in Patients with Stable Chest Pain: A Secondary Analysis of the PROMISE Randomized Clinical Trial.Journal of clinical medicine · 2020Article
- Subclinical atherosclerosis: how and when to treat it?European heart journal supplements : journal of the European Society of Cardiology · 2020Article
Corrections and comments
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Authors and funding
37 authors at 20 institutions in 11 countries.
Funding
Abstract
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 (<50% diameter stenosis) for whom data on baseline statin use was available were included. Coronary artery calcium (CAC) was quantified using the Agatston score. The extent of non-obstructive coronary atherosclerosis was quantified using the segment involvement score (SIS). 8,016 patients were followed for a median of 2.5 years with analysis of all-cause mortality and major adverse cardiac events (MACE) including all-cause mortality, myocardial infarction, unstable angina, target vessel revascularization, and coronary artery disease-related hospitalization.
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.
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