Non-invasive assessment of statin-associated changes using serial CCTA: plaque progression, pericoronary inflammation, and clinical outcomes in non-obstructive CAD

Statins may affect plaque progression and pericoronary inflammation in non-obstructive coronary artery disease (CAD), but longitudinal evidence remains limited. In this retrospective cohort study, 363 patients with non-obstructive CAD undergoing serial CCTA were enrolled, including 209 statin-treated and 154 statin-naïve patients. Changes in plaque characteristics, stenosis severity, and PCAT attenuation were compared between groups. ANCOVA models were performed to evaluate the association between statin use and follow-up imaging parameters after adjustment for corresponding baseline imaging measurements and clinical variables. MACE outcomes were assessed using Kaplan–Meier analysis and multivariable Cox regression. Compared with statin-naïve patients, statin-treated patients showed slower progression of total plaque volume (7.00 ± 23.70 vs. 14.28 ± 28.77 mm³/year, P = 0.009), non-calcified plaque volume (2.45 ± 17.12 vs. 8.24 ± 18.45 mm³/year, P = 0.002), and fibrotic plaque volume (1.08 ± 14.14 vs. 6.78 ± 15.97 mm³/year, P < 0.001). Statin use was also associated with greater reduction in PCAT attenuation (− 1.03 ± 3.00 vs. −0.03 ± 2.80 HU/year, P = 0.001). After adjustment for baseline imaging characteristics and clinical factors, statin use remained associated with lower follow-up total plaque volume, non-calcified plaque volume, fibrotic plaque volume, and PCAT attenuation (all P < 0.01). A weak inverse correlation was observed between PCAT attenuation changes and calcified plaque progression. Kaplan–Meier analysis showed higher MACE-free survival in statin-treated patients, whereas Cox regression demonstrated a non-significant trend toward lower MACE risk after adjustment (HR 0.52, 95% CI 0.23–1.15, P = 0.106). Statin use was associated with slower progression of coronary plaque and reduced PCAT attenuation in patients with non-obstructive CAD. Serial CCTA provides a noninvasive approach to assess treatment-associated changes in plaque characteristics and pericoronary inflammation.