The 2018 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol
management guideline recommends risk enhancers in the borderline-risk and statin recommended/intermediate-risk
groups. We determined the risk reclassification by the presence and severity of coronary
computed tomography angiography (CCTA)-visualized coronary artery disease (CAD) according
to statin eligibility groups. Of 35,281 individuals who underwent CCTA, 1,303 asymptomatic
patients (age 59, 65% male) were identified. Patients were categorized as low risk,
borderline risk, statin recommended/intermediate risk or statin recommended/high risk
according to the guideline. CCTA-visualized CAD was categorized as no CAD, nonobstructive,
or obstructive. Major adverse cardiovascular events (MACE) were defined as a composite
outcome of all-cause mortality, nonfatal myocardial infarction, and late coronary
revascularization (>90 days). We tested a reclassification wherein no CAD reclassifies
downward, and the presence of any CAD reclassifies upward. During a median follow-up
of 2.9 years, 93 MACE events (7.1%) were observed. Among the borderline-risk and statin-recommended/intermediate-risk
groups eligible for risk enhancers, the presence or absence of any CCTA-visualized
CAD led to a net increase of 2.3% of cases and 22.4% of controls correctly classified
(net reclassification index [NRI] 0.27, 95% CI 0.13 to 0.41, p = 0.0002). The NRI
was not significant among low- or statin-recommended/high-risk patients (all p >0.05).
The presence or absence of CCTA-visualized CAD, including both obstructive and nonobstructive
CAD, significantly improves reclassification in patients eligible for risk enhancers
in 2018 ACC/AHA guidelines. Patients in low- and high-risk groups derive no significant
improvement in risk reclassification from CCTA.
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Article info
Publication history
Published online: August 23, 2019
Accepted:
July 29,
2019
Received in revised form:
July 23,
2019
Received:
May 8,
2019
Footnotes
Funding: The research reported in this publication was funded, in part, by the National Institute of Health (Bethesda, MD, USA) under award number R01 HL115150. This research was also supported, in part, by the Dalio Institute of Cardiovascular Imaging (New York, NY, USA) and the Michael Wolk Foundation (New York, NY, USA).
Identification
Copyright
© 2019 Published by Elsevier Inc.
