TY - JOUR

T1 - Prognostic Value of Coronary CT Angiography in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes

AU - Kofoed, Klaus F.

AU - Engstrøm, Thomas

AU - Sigvardsen, Per E.

AU - Linde, Jesper J.

AU - Torp-Pedersen, Christian

AU - de Knegt, Martina

AU - Hansen, Peter R.

AU - Fritz-Hansen, Thomas

AU - Bech, Jan

AU - Heitmann, Merete

AU - Nielsen, Olav W.

AU - Høfsten, Dan

AU - Kühl, Jørgen T.

AU - Raymond, Ilan E.

AU - Kristiansen, Ole P.

AU - Svendsen, Ida H.

AU - Domínguez Vall-Lamora, M. H.

AU - Kragelund, Charlotte

AU - Hove, Jens D.

AU - Jørgensen, Tem

AU - Fornitz, Gitte G.

AU - Steffensen, Rolf

AU - Jurlander, Birgit

AU - Abdulla, Jawdat

AU - Lyngbæk, Stig

AU - Elming, Hanne

AU - Therkelsen, Susette K.

AU - Jørgensen, Erik

AU - Kløvgaard, Lene

AU - Bang, Lia E.

AU - Helqvist, Steffen

AU - Galatius, Søren

AU - Pedersen, Frants

AU - Abildgaard, Ulrik

AU - Clemmensen, Peter

AU - Saunamäki, Kari

AU - Holmvang, Lene

AU - Gislason, Gunnar

AU - Kelbæk, Henning

AU - Køber, Lars V.

N1 - Publisher Copyright: © 2021 American College of Cardiology Foundation

PY - 2021/3/2

Y1 - 2021/3/2

N2 - Background: Severity and extent of coronary artery disease (CAD) assessed by invasive coronary angiography (ICA) guide treatment and may predict clinical outcome in patients with non–ST-segment elevation acute coronary syndrome (NSTEACS). Objectives: This study tested the hypothesis that coronary computed tomography angiography (CTA) is equivalent to ICA for risk assessment in patients with NSTEACS. Methods: The VERDICT (Very Early Versus Deferred Invasive Evaluation Using Computerized Tomography in Patients With Acute Coronary Syndromes) trial evaluated timing of treatment in relation to outcome in patients with NSTEACS and included a clinically blinded coronary CTA conducted prior to ICA. Severity of CAD was defined as obstructive (coronary stenosis ≥50%) or nonobstructive. Extent of CAD was defined as high risk (obstructive left main or proximal left anterior descending artery stenosis and/or multivessel disease) or non–high risk. The primary endpoint was a composite of all-cause death, nonfatal recurrent myocardial infarction, hospital admission for refractory myocardial ischemia, or heart failure. Results: Coronary CTA and ICA were conducted in 978 patients. During a median follow-up time of 4.2 years (interquartile range: 2.7 to 5.5 years), the primary endpoint occurred in 208 patients (21.3%). The rate of the primary endpoint was up to 1.7-fold higher in patients with obstructive CAD compared with in patients with nonobstructive CAD as defined by coronary CTA (hazard ratio [HR]: 1.74; 95% confidence interval [CI]: 1.22 to 2.49; p = 0.002) or ICA (HR: 1.54; 95% CI: 1.13 to 2.11; p = 0.007). In patients with high-risk CAD, the rate of the primary endpoint was 1.5-fold higher compared with the rate in those with non–high-risk CAD as defined by coronary CTA (HR: 1.56; 95% CI: 1.18 to 2.07; p = 0.002). A similar trend was noted for ICA (HR: 1.28; 95% CI: 0.98 to 1.69; p = 0.07). Conclusions: Coronary CTA is equivalent to ICA for the assessment of long-term risk in patients with NSTEACS. (Very Early Versus Deferred Invasive Evaluation Using Computerized Tomography in Patients With Acute Coronary Syndromes [VERDICT]; NCT02061891)

AB - Background: Severity and extent of coronary artery disease (CAD) assessed by invasive coronary angiography (ICA) guide treatment and may predict clinical outcome in patients with non–ST-segment elevation acute coronary syndrome (NSTEACS). Objectives: This study tested the hypothesis that coronary computed tomography angiography (CTA) is equivalent to ICA for risk assessment in patients with NSTEACS. Methods: The VERDICT (Very Early Versus Deferred Invasive Evaluation Using Computerized Tomography in Patients With Acute Coronary Syndromes) trial evaluated timing of treatment in relation to outcome in patients with NSTEACS and included a clinically blinded coronary CTA conducted prior to ICA. Severity of CAD was defined as obstructive (coronary stenosis ≥50%) or nonobstructive. Extent of CAD was defined as high risk (obstructive left main or proximal left anterior descending artery stenosis and/or multivessel disease) or non–high risk. The primary endpoint was a composite of all-cause death, nonfatal recurrent myocardial infarction, hospital admission for refractory myocardial ischemia, or heart failure. Results: Coronary CTA and ICA were conducted in 978 patients. During a median follow-up time of 4.2 years (interquartile range: 2.7 to 5.5 years), the primary endpoint occurred in 208 patients (21.3%). The rate of the primary endpoint was up to 1.7-fold higher in patients with obstructive CAD compared with in patients with nonobstructive CAD as defined by coronary CTA (hazard ratio [HR]: 1.74; 95% confidence interval [CI]: 1.22 to 2.49; p = 0.002) or ICA (HR: 1.54; 95% CI: 1.13 to 2.11; p = 0.007). In patients with high-risk CAD, the rate of the primary endpoint was 1.5-fold higher compared with the rate in those with non–high-risk CAD as defined by coronary CTA (HR: 1.56; 95% CI: 1.18 to 2.07; p = 0.002). A similar trend was noted for ICA (HR: 1.28; 95% CI: 0.98 to 1.69; p = 0.07). Conclusions: Coronary CTA is equivalent to ICA for the assessment of long-term risk in patients with NSTEACS. (Very Early Versus Deferred Invasive Evaluation Using Computerized Tomography in Patients With Acute Coronary Syndromes [VERDICT]; NCT02061891)

KW - acute coronary syndrome

KW - angiography

KW - cardiac computed tomography

KW - prognosis

KW - risk stratification

U2 - 10.1016/j.jacc.2020.12.037

DO - 10.1016/j.jacc.2020.12.037

M3 - Journal article

C2 - 33632478

AN - SCOPUS:85101040952

VL - 77

SP - 1044

EP - 1052

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 8

ER -