A1 Refereed original research article in a scientific journal
Lipid-Lowering Medication and Outcomes After Anatomical and Functional Imaging in Suspected Coronary Artery Disease
Authors: Maaniitty, Teemu; Mäenpää, Matias; Harjulahti, Esa; Kujala, Iida; Stenström, Iida; Nammas, Wail; Knuuti, Juhani; Saraste, Antti
Publisher: American College of Cardiology Foundation
Publication year: 2025
Journal: JACC: Cardiovascular Imaging
Journal name in source: JACC. Cardiovascular imaging
Journal acronym: JACC Cardiovasc Imaging
Volume: 18
Issue: 1
First page : 62
Last page: 73
ISSN: 1936-878X
eISSN: 1876-7591
DOI: https://doi.org/10.1016/j.jcmg.2024.07.009
Web address : https://doi.org/10.1016/j.jcmg.2024.07.009
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/457803431
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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Funding information in the publication:
This study was funded by research grants from the Academy of Finland, the Finnish Foundation for Cardiovascular Research, and Turku University Hospital, as a financial support for the submitted work. The funders had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The authors are independent from the funders. The Turku PET Centre has received an unrestricted research grant from Cleerly, Inc. Dr Saraste has received institutional research contracts from AstraZeneca and Precordior; has received speaker fees from Abbott, Novartis, Bayer, AstraZeneca, and Amgen; has participated in Advisory Boards for AstraZeneca, Amgen, Pfizer, and Boehringer Ingelheim; has a membership of the scientific advisory committee for the Finnish Foundation for Cardiovascular Research; and has a board membership for the European Society of Cardiology. Dr Knuuti has received consulting fees from AstraZeneca and GE Healthcare; has received speaker fees from GE Healthcare, Merck, Lundbeck, Bayer, Boehringer-Ingelheim, Pfizer, and Siemens; and has participated on data safety monitoring or advisory boards. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
