Aspirin and Statin Therapy for Nonobstructive Coronary Artery Disease: Five-yearOutcomes from the CONFIRM Registry

Praveen Indraratna, Christopher Naoum, Sagit Ben Zekry, Heidi Gransar, Philipp Blanke, Stephanie Sellers, Stephan Achenbach, Mouaz H. Al-Mallah, Daniele Andreini, Daniel S. Berman, Matthew J. Budoff, Filippo Cademartiri, Tracy Q. Callister, Hyuk Jae Chang, Kavitha Chinnaiyan, Benjamin J.W. Chow, Ricardo C. Cury, Augustin Delago, Gudrun Feuchtner, Martin HadamitzkyJoerg Hausleiter, Philipp A. Kaufmann, Yong Jin Kim, Erica Maffei, Hugo Marques, Pedro De Araujo Gonsalves, Gianluca Pontone, Gilbert L. Raff, Ronen Rubinshtein, Todd C. Villines, Fay Y. Lin, Leslee J. Shaw, Jagat Narula, Jeroen J. Bax, Jonathon A. Leipsic

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6 Citations (Scopus)


Purpose: In this cohort study, 5-year data from the Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry (ie, CONFIRM) were examined to identify associations of baseline aspirin and statin use with mortality, major adverse cardiovascular events (MACE), and myocardial infarction (MI) in individuals without substantial (>50%) stenosis. Materials and Methods: In this prospective cohort study, all participants in the registry underwent coronary CT angiography and were classified as having no detectable coronary plaque or having nonobstructive coronary artery disease (CAD) (1%—49% stenosis). Participants with obstructive (>50%) stenosis were excluded from analysis. The study commenced in June 2003 and was completed in March 2016. All unadjusted and risk-adjusted analyses utilized the Cox proportional hazard model with hospital sites modeled using shared frailty. Results: A total of 6386 participants with no detectable plaque or with nonobstructive CAD were included (mean age, 56.0 years 6 13.3 [SD], 52% men). The mean follow-up period was 5.66 years 6 1.10. Nonobstructive CAD (n = 2815, 44% of all participants included in the study) was associated with a greater risk of all-cause mortality (10.6% [298 of 2815] vs 4.8% [170 of 3571], P <.001) compared to those without CAD (n = 3571, 56%). Baseline aspirin and statin use was documented for 1415 and 1429 participants, respectively, with nonobstructive CAD, and for 1560 and 1565 participants without detectable plaque, respectively. In individuals with nonobstructive CAD, baseline aspirin use was not associated with a reduction in MACE (10.9% [102 of 936] vs 14.7% [52 of 355], P =.06), all-cause mortality (9.6% [95 of 991] vs 10.9% [46 of424], P =.468), or MI (4.4% [41 of 936] vs 6.2% [22 of 355], P =.18). On multivariate risk-adjusted analysis, baseline statin use was associated with a lower rate of MACE (hazard ratio, 0.59; 95% CI: 0.40, 0. 87; P =.007). Neither therapy improved clinical outcomes for participants with no detectable plaque. Conclusion: In participants with nonobstructive CAD, baseline use of statins, but not of aspirin, was associated with improved clinical outcomes. Neither therapy was associated with benefit in participants without plaque. Clinical trial registration no. NCT01443637 Supplemental material is available for this article.

Original languageEnglish
Article numbere210225
JournalRadiology: Cardiothoracic Imaging
Issue number2
Publication statusPublished - 2022 Apr

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© RSNA, 2022.

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging


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