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Coronary CT Angiography in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome

2020; Elsevier BV; Volume: 75; Issue: 5 Linguagem: Inglês

10.1016/j.jacc.2019.12.012

1558-3597

Jesper J. Linde, Henning Kelbæk, Thomas Fritz Hansen, Per E. Sigvardsen, Christian Torp‐Pedersen, Jan Bech, Merete Heitmann, Olav Wendelboe Nielsen, Dan Eik Høfsten, Jørgen Tobias Kühl, Ilan Raymond, Ole Peter Kristiansen, Ida Hastrup Svendsen, Helena Domínguez, Charlotte Kragelund, Martina Chantal de Knegt, Jens D. Hove, Tem Jørgensen, G. Gleerup, Rolf Steffensen, Birgit Jurlander, Jawdat Abdulla, Stig Lyngbæk, Hanne Elming, Susette Krohn Therkelsen, Erik Jørgensen, Lene Kløvgaard, Lia E. Bang, Peter Riis Hansen, Steffen Helqvist, Søren Galatius, Frants Pedersen, Ulrik Abildgaard, Peter Clemmensen, Kari Saunamäki, Lene Holmvang, Thomas Engstrøm, Gunnar Gislason, Lars Køber, Klaus F. Kofoed,

Acute Myocardial Infarction Research

In patients with non–ST-segment elevation acute coronary syndrome (NSTEACS), coronary pathology may range from structurally normal vessels to severe coronary artery disease. The purpose of this study was to test if coronary computed tomography angiography (CTA) may be used to exclude coronary artery stenosis ≥50% in patients with NSTEACS. The VERDICT (Very Early Versus Deferred Invasive Evaluation Using Computerized Tomography in Patients With Acute Coronary Syndromes) trial (NCT02061891) evaluated the outcome of patients with confirmed NSTEACS randomized 1:1 to very early (within 12 h) or standard (48 to 72 h) invasive coronary angiography (ICA). As an observational component of the trial, a clinically blinded coronary CTA was conducted prior to ICA in both groups. The primary endpoint was the ability of coronary CTA to rule out coronary artery stenosis (≥50% stenosis) in the entire population, expressed as the negative predictive value (NPV), using ICA as the reference standard. Coronary CTA was conducted in 1,023 patients—very early, 2.5 h (interquartile range [IQR]: 1.8 to 4.2 h), n = 583; and standard, 59.9 h (IQR: 38.9 to 86.7 h); n = 440 after the diagnosis of NSTEACS was made. A coronary stenosis ≥50% was found by coronary CTA in 68.9% and by ICA in 67.4% of the patients. Per-patient NPV of coronary CTA was 90.9% (95% confidence interval [CI]: 86.8% to 94.1%) and the positive predictive value, sensitivity, and specificity were 87.9% (95% CI: 85.3% to 90.1%), 96.5% (95% CI: 94.9% to 97.8%) and 72.4% (95% CI: 67.2% to 77.1%), respectively. NPV was not influenced by patient characteristics or clinical risk profile and was similar in the very early and the standard strategy group. Coronary CTA has a high diagnostic accuracy to rule out clinically significant coronary artery disease in patients with NSTEACS.