• Benjamin J W Chow, Gary Small, Yeung Yam, Li Chen, Ruth McPherson, Stephan Achenbach, Mouaz Al-Mallah, Daniel S Berman, Matthew J Budoff, Filippo Cademartiri, Tracy Q Callister, Hyuk-Jae Chang, Victor Y Cheng, Kavitha Chinnaiyan, Ricardo Cury, Augustin Delago, Allison Dunning, Gundrun Feuchtner, Martin Hadamitzky, Jörg Hausleiter, Ronald P Karlsberg, Philipp A Kaufmann, Yong-Jin Kim, Jonathon Leipsic, Troy LaBounty, Fay Lin, Erica Maffei, Gilbert L Raff, Leslee J Shaw, Todd C Villines, James K Min, and CONFIRM Investigators.
• From the Department of Medicine (Cardiology), University of Ottawa Heart Institute, Ottawa, Ontario, Canada (B.J.W.C., G.S., Y.Y., L.C., R.M.); Department of Medicine, University of Erlangen, Erlangen, Germany (S.A.); Department of Medicine, Henry Ford Hospital, Wayne State University, Detroit, MI (M.A.-M.); Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA (D.S.B., V.Y.C., T.L.); Department of Medicine, Harbor University of California, Los Angeles Medical Center (M.J.B.); Department of Radiology, Giovanni XXIII Hospital, Monastier di Treviso, Italy (F.C., E.M.); Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (F.C., E.M.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Division of Cardiology, Severance Cardiovascular Hospital, Seoul, Korea (H.-J.C.); William Beaumont Hospital, Royal Oaks, MI (K.C.); Baptist Cardiac and Vascular Institute, Miami, FL (R.C.); Capitol Cardiology Associates, Albany, NY (A.D.); Department of Public Health (A.D.), Medicine and Radiology (F.L.), and Department of Radiology (J.K.M.), New York Presbyterian Hospital and the Weill Cornell Medical College; Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria (G.F.); Division of Cardiology, Technische Universität München, Munich, Germany (M.H., J.H.); Cardiovascular Medical Group, Los Angeles, CA (R.P.K.); Cardiac Imaging, University Hospital, Zurich, Switzerland (P.A.K.); Seoul National University Hospital, Seoul, South Korea (Y.-J.K.); Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada (J.L.); Department of Cardiology, William Beaumont Hospital, Royal Oaks, MI (G.L.R.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (L.J.S.); and Department of Medicine, Walter Reed Medical Center, Washington, DC (T.C.V.).
• Arterioscler. Thromb. Vasc. Biol. 2015 Apr 1;35(4):981-9.

ObjectiveWe sought to examine the risk of mortality associated with nonobstructive coronary artery disease (CAD) and to determine the impact of baseline statin and aspirin use on mortality.Approach And ResultsCoronary computed tomographic angiography permits direct visualization of nonobstructive CAD. To date, the prognostic implications of nonobstructive CAD and the potential benefit of directing therapy based on nonobstructive CAD have not been carefully examined. A total of 27 125 consecutive patients who underwent computed tomographic angiography (12 enrolling centers and 6 countries) were prospectively entered into the COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry. Patients, without history of previous CAD or obstructive CAD, for whom baseline statin and aspirin use was available were analyzed. Each coronary segment was classified as normal or nonobstructive CAD (1%-49% stenosis). Patients were followed up for a median of 27.2 months for all-cause mortality. The study comprised 10 418 patients (5712 normal and 4706 with nonobstructive CAD). In multivariable analyses, patients with nonobstructive CAD had a 6% (95% confidence interval, 1%-12%) higher risk of mortality for each additional segment with nonobstructive plaque (P=0.021). Baseline statin use was associated with a reduced risk of mortality (hazard ratio, 0.44; 95% confidence interval, 0.28-0.68; P=0.0003), a benefit that was present for individuals with nonobstructive CAD (hazard ratio, 0.32; 95% confidence interval, 0.19-0.55; P<0.001) but not for those without plaque (hazard ratio, 0.66; 95% confidence interval, 0.30-1.43; P=0.287). When stratified by National Cholesterol Education Program/Adult Treatment Program III, no mortality benefit was observed in individuals without plaque. Aspirin use was not associated with mortality benefit, irrespective of the status of plaque.ConclusionsThe presence and extent of nonobstructive CAD predicted mortality. Baseline statin therapy was associated with a significant reduction in mortality for individuals with nonobstructive CAD but not for individuals without CAD.Clinical Trial RegistrationURL: http://clinicaltrials.gov/. Unique identifier NCT01443637.© 2015 American Heart Association, Inc.

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