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

Jesper J Linde, Henning Kelbæk, Thomas Fritz Hansen, Per E Sigvardsen, Christian Tobias Torp-Pedersen, Jan Bech, Merete Heitmann, Olav W Nielsen, Dan Høfsten, Jørgen T Kühl, Ilan E Raymond, Ole P Kristiansen, Ida H Svendsen, Maria H D Vall-Lamora, Charlotte Kragelund, Martina de Knegt, Jens D Hove, Tem Jørgensen, Gitte G Fornitz, Rolf SteffensenBirgit Jurlander, Jawdat Abdulla, Stig Lyngbæk, Hanne Elming, Susette K Therkelsen, Erik Jørgensen, Lene Kløvgaard, Lia Evi Bang, Peter Riis Hansen, Steffen Helqvist, Søren Galatius, Frants Pedersen, Ulrik Abildgaard, Peter Clemmensen, Kari Saunamäki, Lene Holmvang, Thomas Engstrøm, Gunnar Gislason, Lars V Køber, Klaus F Kofoed

Research output: Contribution to journalJournal articleResearchpeer-review

140 Citations (Scopus)

Abstract

BACKGROUND: In patients with non-ST-segment elevation acute coronary syndrome (NSTEACS), coronary pathology may range from structurally normal vessels to severe coronary artery disease.

OBJECTIVES: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: Coronary CTA has a high diagnostic accuracy to rule out clinically significant coronary artery disease in patients with NSTEACS.

Original languageEnglish
JournalJournal of the American College of Cardiology
Volume75
Issue number5
Pages (from-to)453-463
ISSN0735-1097
DOIs
Publication statusPublished - 2020

Keywords

  • Acute Coronary Syndrome/diagnostic imaging
  • Aged
  • Computed Tomography Angiography
  • Coronary Angiography
  • Coronary Stenosis/diagnostic imaging
  • Female
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prospective Studies

Cite this