Impact of coronary computed tomographic angiography findings on the medical treatment and control of coronary artery disease and its risk factors.
Although coronary computed tomographic angiography (CCTA) has high diagnostic accuracy and increasing evidence of prognostic value for coronary artery disease (CAD), its downstream clinical impact is not established. In this study, the association of findings on CCTA with subsequent treatment and control of CAD risk factors was assessed in 208 consecutive symptomatic outpatients without known CAD who underwent CCTA. Blood pressure (BP), lipid levels, and CAD medications were compared before and after CCTA (mean follow-up period 8.1 +/- 6.6 months). CAD severity on CCTA was graded as absent, mild (1% to 49%), moderate (50% to 69%), or severe (> or =70%) stenosis. In patients with absent, mild, moderate, and severe CAD on CCTA, aspirin was initiated in 0%, 14%, 36%, and 15%; statins were initiated or increased in 4%, 23%, 44%, and 42% of patients; and BP medications were initiated or increased in 16%, 10%, 26%, and 38% of patients (p <0.05 for severe vs no CAD for all). Higher grades of CAD severity were independently associated with greater post-CCTA use of aspirin (odds ratio 3.2 per grade, p <0.001) and statins (odds ratio 3.6 per grade, p <0.001), but not BP medications. Greater CAD severity was independently associated with lower post-test total cholesterol (-8.2 mg/dl per grade, p = 0.02), low-density lipoprotein cholesterol (-6.8 mg/dl per grade, p = 0.04), and diastolic BP (-1.4 mm Hg per grade, p = 0.03), but not systolic BP. In conclusion, greater CAD severity on CCTA is associated with enhanced medical treatment and improved control of CAD risk factors.
LaBounty
Troy M
TM
Department of Medicine, Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA. tml9001@med.cornell.edu
Devereux
Richard B
RB
Lin
Fay Y
FY
Weinsaft
Jonathan W
JW
Min
James K
JK
D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D023921:Coronary Stenosis / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001241:Aspirin