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. 2021 Mar 2;77(8):1044-1052.
doi: 10.1016/j.jacc.2020.12.037.

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

Klaus F Kofoed  1 , Thomas Engstrøm  2 , Per E Sigvardsen  2 , Jesper J Linde  2 , Christian Torp-Pedersen  3 , Martina de Knegt  2 , Peter R Hansen  3 , Thomas Fritz-Hansen  3 , Jan Bech  4 , Merete Heitmann  4 , Olav W Nielsen  4 , Dan Høfsten  2 , Jørgen T Kühl  5 , Ilan E Raymond  5 , Ole P Kristiansen  4 , Ida H Svendsen  4 , M H Domínguez Vall-Lamora  4 , Charlotte Kragelund  3 , Jens D Hove  6 , Tem Jørgensen  6 , Gitte G Fornitz  6 , Rolf Steffensen  7 , Birgit Jurlander  7 , Jawdat Abdulla  6 , Stig Lyngbæk  8 , Hanne Elming  5 , Susette K Therkelsen  5 , Erik Jørgensen  2 , Lene Kløvgaard  2 , Lia E Bang  2 , Steffen Helqvist  2 , Søren Galatius  3 , Frants Pedersen  2 , Ulrik Abildgaard  3 , Peter Clemmensen  9 , Kari Saunamäki  3 , Lene Holmvang  2 , Gunnar Gislason  3 , Henning Kelbæk  5 , Lars V Køber  2
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Free article

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

Klaus F Kofoed et al. J Am Coll Cardiol. .
Free article

Abstract

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).

Keywords: acute coronary syndrome; angiography; cardiac computed tomography; prognosis; risk stratification.

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Conflict of interest statement

Funding Support and Author Disclosures This study was funded by the Danish Agency for Science, Technology, and Innovation and the Danish Council for Strategic Research (grant 09–066994) and the Research Council of Rigshospitalet, Copenhagen, Denmark. Dr. Kofoed has received grants from the Danish Research Foundation during the conduct of the study, in addition to grants from the Research Council of Rigshospitalet, AP Moller og Hustru Chastine McKinney Mollers Fond, the Danish Heart Foundation, and Canon Medical Corporation, outside the submitted work. Dr. Engstrom has received personal fees from Abbott, AstraZeneca, Bayer, Boston Scientific, and Novo, outside the submitted work. Dr. Linde has received grants from the Danish Research Foundation and the Research Council of Rigshospitalet during the conduct of the study. Dr. Torp-Pedersen has received grants from Bayer, outside the submitted work. Dr. Abdulla has received personal fees from Novartis Healthcare, outside the submitted work. Dr. Kober has received grants from the Danish Research Foundation during the conduct of the study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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