Antianginal medication after non-invasive diagnosis of coronary artery disease

Background: Coronary computed tomography angiography (CCTA) enables non-invasive anatomical assessment of coronary artery disease (CAD), while positron emission tomography (PET) myocardial perfusion imaging detects myocardial ischemia. We studied how CCTA and PET findings influence the subsequent use of antianginal medication. Methods: In this observational cohort study, 2260 consecutive patients (40% male, median age 63 years) with new-onset symptoms suggestive of CAD underwent CCTA with selective PET perfusion imaging between 2007 and 2017. Use of beta blockers (BB), nitrates and calcium channel blockers (CCB) was assessed from national registry data on drug purchases from 1 year before to 1 year after imaging. Early myocardial revascularization was recorded within 6 months after imaging. Long-term outcomes included allcause mortality, myocardial infarction (MI) and unstable angina pectoris (UAP). Results: Increasing severity of CAD on CCTA/PET imaging was associated with stepwise increase in antianginal medication use, particularly BBs (35% in patients without CAD vs. 77% in ischemic obstructive CAD, p