Statin use in patients with coronary atheroma identified on computed tomography coronary angiography: current practice in South Auckland, New Zealand (ANZACS-QI 82)

AIM: Computed tomography coronary angiography (CTCA) is a sensitive tool for the diagnosis of atherosclerotic coronary artery disease (CAD). The study aim was to determine whether the finding of coronary atheroma on CTCA was associated with the subsequent use of statin therapy. METHODS: Patients with chest pain who underwent CTCA in 2020-2021 were identified from the Aotearoa New Zealand All Cardiology Services Quality Improvement (ANZACS-QI) cardiac computed tomography (CT) registry at Middlemore Hospital, Auckland, New Zealand. Patients were categorised into three groups: no atheroma, atheroma with non-obstructive CAD and atheroma with obstructive CAD. RESULTS: There were 548 patients with acute chest pain and 746 with stable chest pain. Of those with acute chest pain, no atheroma, non-obstructive and obstructive CAD was documented in 37.2%, 38% and 24.8%, respectively. In patients with obstructive CAD, statin dispensing was 52.9% pre-admission, 92.6% early post-CTCA and 87.5% at 1 year. In those with non-obstructive CAD, statin dispensing was 45.7% pre-admission, 67.8% early post-CTCA and 59.6% at 1 year. In those without atheroma, statins were dispensed in 23.5% at pre-admission and in 28.9% at 1 year. In the stable chest pain cohort, patterns of statin dispensing post-CTCA were similar to those in the acute chest pain cohort. On multivariate regression the presence of atheroma both with/without obstructive CAD was associated with higher levels of statin dispensing. CONCLUSION: The finding of atheroma with obstructive CAD on CTCA is associated with appropriate increases in statin use. There are opportunities to optimise care by greater statin utilisation in non-obstructive CAD and down-titration in those without atheroma.