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Title Statin and antiplatelet initiation in patients with a normal stress single photon emission computed tomographic myocardial perfusion imaging and elevated coronary artery calcium score |
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Type Young Investigator Award |
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Theme ACC Asia & SCS 32nd Annual Scientific Meeting |
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Topic Non-Invasive Cardiac Imaging, Echocardiography, Nuclear Cardiology / Adult Congenital Heart Disease / Cardiac Surgery |
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Main Author Yi Hui To1 |
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Presenting Author Yi Hui To1 |
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Co-Author Xi Min Tan1 Cher-Lyn Low1 Htet Htet Min3 Min Sen Yew2 |
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Department / Institution / Country Yong Loo Lin School of Medicine / National University of Singapore / Singapore1 Department of Cardiology / Tan Tock Seng Hospital / Singapore2 Cardiac Medical Department / Yangon General Hospital / Myanmar (Burma) (မြန်မာ)3 |
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Objective(s) Coronary artery calcium (CAC) scoring gives additional prognostic information over stress Single Photon Emission Computed Tomographic (SPECT) Myocardial Perfusion Imaging (MPI). High CAC is associated with increased major adverse cardiac and cerebrovascular events (MACCE) despite normal stress MPI (nsMPI). Moderate-high intensity statins (MHIS) and antiplatelets are recommended for high CAC. We aim to assess the practices and impact of statin/antiplatelet initiation in patients with nsMPI and elevated CAC. |
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Material and Method Retrospective review of nsMPIs performed between 1 March 2016 – 31 January 2017 with simultaneously measured CAC score >300. Cases with post-stress left ventricular ejection fraction <50% were excluded. Clinical data including statin/antiplatelet prescriptions and MACCE at 24 months (cardiac death, acute coronary syndrome, ischaemic stroke) were traced using electronic records. |
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Result(s) There were 311 nsMPIs meeting inclusion criteria (56.3% male, 50.1% diabetic). Median age was 71 (49 - 97) years. There were 215 (69.1%) on statins at baseline, of which 69.3% were MHIS. Post MPI, 52.1% of statin-naïve patients were started on statins (all MHIS) and 2/66 (3.0%) were escalated from low intensity statins (LIS) to MHIS. Antiplatelet/anticoagulation was used by 46.9% at baseline, with a further 56/165 (33.9%) initiated post-MPI. Reasons for not starting antiplatelet were documented in 10.1%, of which anaemia/bleeding risk (54.6%) and patient refusal (36.4%) were most common. MACCE within 24 months was significantly lower in patients taking MHIS compared to LIS or no statins post-MPI (3.5% vs 6.4% vs 13.0%, p=0.034). There was no significant difference in MACCE between patients with or without antiplatelets/anticoagulation post-MPI (2.5% vs 7.3%, p=0.070). |
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Conclusion A substantial proportion of patients with nsMPI and high CAC do not receive MHIS/antiplatelets. Post-MPI MHIS use is associated with lower 24-month MACCE. There is a need to promote greater awareness of the importance of aggressive medical therapy for high CAC despite a nsMPI. |