{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T03:16:39Z","timestamp":1760238999805,"version":"build-2065373602"},"reference-count":23,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2020,9,24]],"date-time":"2020-09-24T00:00:00Z","timestamp":1600905600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["TA 1438\/1-2"],"award-info":[{"award-number":["TA 1438\/1-2"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Recommendations for preventive statin treatment in patients with stable chest pain may be difficult as symptoms can be unspecific. It is unclear if coronary CT angiography (CTA)-detected coronary artery disease (CAD) can optimize statin prescription. Methods: In stable chest pain patients randomized to CTA in the PROMISE trial, statin eligibility was defined per 2018 American College of Cardiology\/American Heart Association (ACC\/AHA) guidelines. Primary outcome was a composite of death, myocardial infarction or unstable angina over 26 months median follow-up. Hazard ratios (HR) of non-obstructive (1\u201369% stenosis) and obstructive (\u226570% stenosis) CAD for events were determined using Cox proportional hazard models. Calculated HR were then incorporated into the ACC\/AHA pooled cohort equation (PCE) to revised ASCVD risk and assess re-classification of statin eligibility. Results: Among 3986 patients (60.5 \u00b1 8.2 years; 51% female), 72.9% (2904\/3986) were statin eligible. Event rates in statin-eligible vs. ineligible patients were 3.3% vs. 2.3% (HR = 1.4 (95% CI 0.9\u20132.2), p = 0.142). Although the proportion of statin-eligible patients increased with CAD severity, 54% without CAD were statin eligible. Incorporating information on CAD into PCE reclassified 12.7% of patients (1.3% towards statin, 11.4% towards no statin). Similar results were found in stratified analysis of statin na\u00efve patients (reclassification of 13.9%, 1.0% towards statin, and 12.9% towards no statin). As a result, revised ASCVD risk improved model discrimination in all patients (c-statistic: 0.59 (95 %CI 0.55\u20130.62) vs. 0.52 (95 %CI 0.49\u20130.56); p 0.001), while reducing statin use by 10.1% (62.7% vs. 72.9% statin eligible, p 0.001). Conclusion: In stable chest pain patients, integration of CAD into guideline recommendations was associated with greater accuracy to reclassify those at increased risk for incident events and a more efficient use of statins.<\/jats:p>","DOI":"10.3390\/jcm9103076","type":"journal-article","created":{"date-parts":[[2020,9,24]],"date-time":"2020-09-24T08:33:03Z","timestamp":1600936383000},"page":"3076","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Guideline-Based Statin Eligibility, Coronary Artery Stenosis and Cardiovascular Events in Patients with Stable Chest Pain: A Secondary Analysis of the PROMISE Randomized Clinical Trial"],"prefix":"10.3390","volume":"9","author":[{"given":"Amit","family":"Pursnani","sequence":"first","affiliation":[{"name":"Cardiology Division, NorthShore University Health System, Evanston, IL 60201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1388-7531","authenticated-orcid":false,"given":"Jana","family":"Taron","sequence":"additional","affiliation":[{"name":"Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA"},{"name":"Department of Radiology, Freiburg University Hospital, 79106 Freiburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Mayrhofer","sequence":"additional","affiliation":[{"name":"Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA"},{"name":"School of Business Studies, Stralsund University of Applied Sciences, 81435 Stralsund, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4696-9610","authenticated-orcid":false,"given":"Michael T.","family":"Lu","sequence":"additional","affiliation":[{"name":"Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maros","family":"Ferencik","sequence":"additional","affiliation":[{"name":"Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR 97239, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph A.","family":"Ladapo","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela S.","family":"Douglas","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27708, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Udo","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Grundy, S.M., Stone, N.J., Bailey, A.L., Beam, C., Birtcher, K.K., Blumenthal, R.S., Braun, L.T., de Ferranti, S., Faiella-Tommasino, J., and Forman, D.E. (2018). 2018 AHA\/ACC\/AACVPR\/AAPA\/ABC\/ACPM\/ADA\/AGS\/APhA\/ASPC\/NLA\/PCNA Guideline on the Management of Blood Cholesterol. J. Am. Coll. Cardiol.","DOI":"10.1016\/j.jacc.2018.11.003"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1056\/NEJMoa1415516","article-title":"Outcomes of Anatomical versus Functional Testing for Coronary Artery Disease","volume":"372","author":"Douglas","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.jcct.2013.05.009","article-title":"Multi-Ethnic Study of Atherosclerosis and the Investigator Group of the Heinz Nixdorf RECALL Study, A comparison of outcomes with coronary artery calcium scanning in unselected populations: The Multi-Ethnic Study of Atherosclerosis (MESA) and Heinz Nixdorf RECALL study (HNR)","volume":"7","author":"Budoff","year":"2013","journal-title":"J. Cardiovasc. Comput. Tomogr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2320","DOI":"10.1161\/CIRCULATIONAHA.116.024360","article-title":"Prognostic Value of Noninvasive Cardiovascular Testing in Patients With Stable Chest Pain: Insights From the PROMISE Trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain)","volume":"135","author":"Hoffmann","year":"2017","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1161\/CIRCIMAGING.111.964155","article-title":"Incremental Prognostic Value of Cardiac Computed Tomography in Coronary Artery Disease Using CONFIRM: COroNary Computed Tomography Angiography Evaluation for Clinical Outcomes: An InteRnational Multicenter Registry","volume":"4","author":"Chow","year":"2011","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1016\/j.ahj.2014.03.003","article-title":"PROspective Multicenter Imaging Study for Evaluation of chest pain: Rationale and design of the PROMISE trial","volume":"167","author":"Douglas","year":"2014","journal-title":"Am. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1016\/0735-1097(90)90282-T","article-title":"Quantification of coronary artery calcium using ultrafast computed tomography","volume":"15","author":"Agatston","year":"1990","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1016\/j.jcmg.2016.10.022","article-title":"Nonobstructive Coronary Artery Disease by Coronary CT Angiography Improves Risk Stratification and Allocation of Statin Therapy","volume":"10","author":"Emami","year":"2017","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_9","first-page":"S49","article-title":"2013 ACC\/AHA Guideline on the Assessment of Cardiovascular Risk","volume":"129","author":"Bennett","year":"2014","journal-title":"Circulation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2543","DOI":"10.1001\/jama.1982.03320430047030","article-title":"Evaluating the Yield of Medical Tests","volume":"247","author":"Harrell","year":"1982","journal-title":"JAMA"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/j.jacc.2009.07.072","article-title":"The Absence of Coronary Calcification Does Not Exclude Obstructive Coronary Artery Disease or the Need for Revascularization in Patients Referred for Conventional Coronary Angiography","volume":"55","author":"Gottlieb","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1001\/jama.2015.7515","article-title":"Guideline-Based Statin Eligibility, Coronary Artery Calcification, and Cardiovascular Events","volume":"314","author":"Pursnani","year":"2015","journal-title":"JAMA"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1093\/ehjci\/jes060","article-title":"Meaning of zero coronary calcium score in symptomatic patients referred for coronary computed tomographic angiography","volume":"13","author":"Kim","year":"2012","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/S0828-282X(10)70419-0","article-title":"Prevalence of non-calcified coronary plaque on 64-slice computed tomography in asymptomatic patients with zero and low coronary artery calcium","volume":"26","author":"Iwasaki","year":"2010","journal-title":"Can. J. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Bittner, D.O., Mayrhofer, T., Budoff, M., Szilveszter, B., Foldyna, B., Hallett, T.R., Ivanov, A., Janjua, S., Meyersohn, N.M., and Staziaki, P.V. (2019). Prognostic Value of Coronary CTA in Stable Chest Pain: CAD-RADS, CAC, and Cardiovascular Events in PROMISE. JACC Cardiovasc. Imaging.","DOI":"10.1016\/j.jcmg.2019.09.012"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Pencina, M.J., Navar-Boggan, A.M., D\u2019Agostino, R.B.S., Williams, K., Neely, B., Sniderman, A.D., and Peterson, E.D. (2014). Application of new cholesterol guidelines to a population-based sample. N. Engl. J. Med.","DOI":"10.1056\/NEJMoa1315665"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1016\/S0140-6736(09)61965-6","article-title":"Statins and risk of incident diabetes: A collaborative meta-analysis of randomised statin trials","volume":"375","author":"Sattar","year":"2010","journal-title":"Lancet"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1161\/01.CIR.0000135215.75876.41","article-title":"Regression of Coronary Atherosclerosis by Simvastatin","volume":"110","author":"Okkels","year":"2004","journal-title":"Circulation"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1001\/jama.291.9.1071","article-title":"Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: A randomized controlled trial","volume":"291","author":"Nissen","year":"2004","journal-title":"JAMA"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Cho, Y.-K., Nam, C.-W., Koo, B.-K., Schulman-Marcus, J., Hartaigh, B.\u00d3., Gransar, H., Lu, Y., Achenbach, S., Al-Mallah, M., and Andreini, D. (2018). Usefulness of baseline statin therapy in non-obstructive coronary artery disease by coronary computed tomographic angiography: From the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) study. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0207194"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1161\/ATVBAHA.114.304351","article-title":"Prognostic and Therapeutic Implications of Statin and Aspirin Therapy in Individuals With Nonobstructive Coronary Artery Disease","volume":"35","author":"Gary","year":"2015","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1016\/j.jcct.2016.08.003","article-title":"Prognostic implications of coronary CT angiography-derived quantitative markers for the prediction of major adverse cardiac events","volume":"10","author":"Tesche","year":"2016","journal-title":"J. Cardiovasc. Comput. Tomogr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1148\/radiol.14140933","article-title":"High-Risk Coronary Plaque at Coronary CT Angiography Is Associated with Nonalcoholic Fatty Liver Disease, Independent of Coronary Plaque and Stenosis Burden: Results from the ROMICAT II Trial","volume":"274","author":"Puchner","year":"2015","journal-title":"Radiology"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/10\/3076\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:13:13Z","timestamp":1760177593000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/10\/3076"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,24]]},"references-count":23,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2020,10]]}},"alternative-id":["jcm9103076"],"URL":"https:\/\/doi.org\/10.3390\/jcm9103076","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2020,9,24]]}}}