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Lipid-Lowering Medication and Outcomes After Anatomical and Functional Imaging in Suspected Coronary Artery Disease. | LitMetric

AI Article Synopsis

  • The study investigates how anatomical and functional imaging of coronary artery disease (CAD) affects the use of lipid-lowering medication (LLM) and patient outcomes over time.
  • It involved nearly 2,000 patients, with varying degrees of CAD, who underwent imaging and ischemia testing; the findings showed that LLM use was notably higher in patients with more severe CAD.
  • Results indicated that patients with myocardial ischemia and obstructive CAD who used LLM experienced fewer adverse events, highlighting the importance of imaging in guiding treatment decisions.

Article Abstract

Background: Anatomical and functional imaging identify different phenotypes of coronary artery disease (CAD) that may have implications for lipid-lowering medication (LLM).

Objectives: The aim of this study was to assess the associations between LLM and long-term outcomes after combined anatomical and functional imaging in patients with suspected obstructive CAD.

Methods: Consecutive patients (n = 1,973; 41% men; median age: 63 years) underwent coronary computed tomography angiography (CTA) because of suspected CAD. Patients in whom obstructive CAD was not ruled out by CTA underwent ischemia testing by positron emission tomography. Data on LLM purchases were collected until 2 years, and the combined endpoints of death, myocardial infarction, and unstable angina pectoris were assessed at a median of 6.7 years.

Results: After imaging, LLM was used by 24% of patients with no CAD, 51% of patients with nonobstructive CAD, 72% of patients with obstructive CAD on CTA without myocardial ischemia, and 91% of patients with myocardial ischemia. The use of LLM decreased during follow-up, with 77% of patients with myocardial ischemia using LLM for 2 years. The use of LLM was associated with a lower annual rate of adverse events in patients with myocardial ischemia (6.1% vs 2.8%; P = 0.032) or obstructive CAD without myocardial ischemia (2.9% vs 1.4%; P = 0.004) but not in patients with nonobstructive CAD (1.5% vs 1.4%; P = 0.89) or no CAD (0.3% vs 0.3%; P = 0.68).

Conclusions: The CAD phenotype defined by anatomical and functional imaging guides the use of LLM. The presence of myocardial ischemia and anatomical obstructive coronary lesions were associated with a long-term outcome benefit from LLM.

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Source
http://dx.doi.org/10.1016/j.jcmg.2024.07.009DOI Listing

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