1. Prognostic Value of Coronary CT Angiography in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes
- Author
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Klaus F. Kofoed, Susette K. Therkelsen, Rolf Steffensen, Henning Kelbæk, Lene Kløvgaard, Tem Jørgensen, Ida Hastrup Svendsen, Thomas Engstrøm, Ilan Raymond, Stig Lyngbæk, Steffen Helqvist, Frants Pedersen, Merete Heitmann, Peter Clemmensen, Jawdat Abdulla, Jørgen Tobias Kühl, Lene Holmvang, Christian Torp-Pedersen, Birgit Jurlander, Gunnar Gislason, Gitte G. Fornitz, Søren Galatius, Per E Sigvardsen, Kari Saunamäki, Jesper J. Linde, Lars Køber, Martina Chantal de Knegt, Ole Peter Kristiansen, Lia E. Bang, Jens D. Hove, Charlotte Kragelund, Dan Eik Høfsten, Peter Riis Hansen, Erik Jørgensen, Hanne Elming, Thomas Fritz-Hansen, Jan Bech, M H Domínguez Vall-Lamora, Ulrik Abildgaard, and Olav W. Nielsen
- Subjects
Male ,medicine.medical_specialty ,Acute coronary syndrome ,Computed Tomography Angiography ,Myocardial Infarction ,Myocardial Ischemia ,risk stratification ,030204 cardiovascular system & hematology ,Risk Assessment ,Severity of Illness Index ,acute coronary syndrome ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Internal medicine ,medicine ,Clinical endpoint ,ST segment ,Humans ,angiography ,030212 general & internal medicine ,cardiovascular diseases ,Acute Coronary Syndrome ,cardiac computed tomography ,Aged ,Heart Failure ,medicine.diagnostic_test ,business.industry ,Hazard ratio ,Coronary Stenosis ,medicine.disease ,Prognosis ,Heart failure ,Angiography ,Cardiology ,Female ,prognosis ,Cardiology and Cardiovascular Medicine ,business - 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 )
- Published
- 2021
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