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.

中文翻译：

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疑似冠状动脉疾病的降脂药物和解剖和功能成像后的结果。


背景解剖和功能成像识别冠状动脉疾病（CAD）的不同表型，这可能对降脂药物（ LLM ）有影响。目的 本研究的目的是评估LLM与疑似阻塞性 CAD 患者联合解剖和功能成像后的长期结果之间的关联。方法 连续患者（n = 1,973；41% 为男性；中位年龄：63 岁）因疑似 CAD 接受冠状动脉计算机断层扫描血管造影 (CTA)。 CTA 未能排除阻塞性 CAD 的患者接受了正电子发射断层扫描的缺血测试。收集LLM购买数据直至 2 年，并在中位数 6.7 年时评估死亡、心肌梗塞和不稳定心绞痛的综合终点。结果 影像学检查后，24% 的无 CAD 患者、51% 的非阻塞性 CAD 患者、72% 的 CTA 上无心肌缺血的梗阻性 CAD 患者和 91% 的心肌缺血患者使用了LLM 。随访期间LLM的使用减少，77%的心肌缺血患者使用LLM达2年。 LLM的使用与心肌缺血患者（6.1% vs 2.8%；P = 0.032）或无心肌缺血的阻塞性 CAD 患者（2.9% vs 1.4%；P = 0.004）的年不良事件发生率较低相关，但在非心肌缺血患者中则不然。患有非阻塞性 CAD 的患者（1.5% vs 1.4%；P = 0.89）或无 CAD 的患者（0.3% vs 0.3%；P = 0.68）。结论 由解剖和功能成像定义的 CAD 表型指导了LLM的使用。心肌缺血和解剖学阻塞性冠状动脉病变的存在与LLM的长期结果获益相关。