Abstract 15238: Impact of Statins on All-Cause Mortality in Subjects With Severe Coronary Artery Calcium Score: Results Form the Confirm (Coronary Ct Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) Registry

Introduction: Coronary artery calcium (CAC) score improves prognostic accuracy of atherosclerotic cardiovascular disease outcomes. However, the relative impact of statins on outcomes stratified by CAC score is limited. Methods: The open-label, 12-center, 6-country prospective longitudinal CONFIRM registry was queried. Individuals with severe CAC (≥300), with long term follow up were selected. Subjects with prior ASCVD events were excluded. The primary study end point was all-cause mortality (ACM) which was compared in individuals on stain versus those not on statin. Kaplan-Meier cumulative incidence curves were performed and compared with log rank test. Multivariate Cox proportional hazard regression analysis was used to calculate hazard ratio (HR) with 95% confidence interval (CI). Results: Of 21,863 participants from the CONFRIM registry, 5,928 had no prior ASCVD events and had information on CAC and statin use. Of these, 972 had a CAC score of ≥300. The mean age of statin users and non-users with CAC≥300 was similar at 67.7± 9.0 vs. 66.9±10.5; p=0.166, and both groups were predominantly male (70% vs 69%, p=0.736). Statin users were more likely to have high cholesterol (93% vs 43%), hypertension (74% vs. 67%), diabetes mellitus (27% vs 20%), family history of cardiovascular disease (41% vs. 34%) and less likely to be a current smoker (22% vs 34%); all p<0.05. There were 42 (9%) deaths over a mean follow-up of 4.2 years among statin users and 86 (18%) deaths over 3.9 years in non-users. In multivariable proportional hazard Cox modeling with a reference group of non-statin users, statin participants with CAC of ≥300 had significantly reduced risk for ACM, HR 0.52- (95% CI, 0.33-0.82, p=0.005). Conclusions: In this large prospective registry, in the primary prevention cohort of patients without prior ASCVD events, severe CAC ≥ 300 identified patients most likely to benefit from statin use. Statins lowered ACM in patients with CAC≥ 300 by 48%.