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

Klaus F Kofoed1, Thomas Engstrøm2, Per E Sigvardsen2

  • 1Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

Journal of the American College of Cardiology
|February 26, 2021
PubMed

Insights

Coronary computed tomography angiography (CTA) is as effective as invasive coronary angiography (ICA) for assessing long-term risk in non-ST-segment elevation acute coronary syndrome (NSTEACS) patients. This finding supports CTA as a valuable tool for risk stratification in NSTEACS.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Clinical Trials

Background:

  • Coronary artery disease (CAD) severity and extent, typically assessed via invasive coronary angiography (ICA), guide treatment and predict outcomes in non-ST-segment elevation acute coronary syndrome (NSTEACS).
  • Risk assessment in NSTEACS is crucial for guiding clinical management and improving patient prognosis.

Purpose of the Study:

  • To test the hypothesis that coronary computed tomography angiography (CTA) is equivalent to ICA for risk assessment in patients with NSTEACS.
  • To evaluate the role of CTA in stratifying risk based on CAD severity and extent in NSTEACS.

Main Methods:

  • The VERDICT trial enrolled 978 patients with NSTEACS, performing both coronary CTA and ICA.
  • CAD severity was defined as obstructive (stenosis ≥50%) or nonobstructive; extent was high-risk (e.g., left main or multivessel disease) or non-high-risk.
  • The primary endpoint was a composite of death, recurrent myocardial infarction, refractory ischemia, or heart failure, assessed over a median follow-up of 4.2 years.

Main Results:

  • The primary endpoint occurred in 21.3% of patients.
  • Obstructive CAD, identified by CTA, was associated with a 1.74-fold higher risk of the primary endpoint compared to nonobstructive CAD (p=0.002).
  • High-risk CAD by CTA showed a 1.56-fold increased risk (p=0.002), with similar trends observed for ICA.

Conclusions:

  • Coronary CTA is equivalent to ICA for assessing long-term risk in patients with NSTEACS.
  • CTA provides a reliable non-invasive method for risk stratification in this patient population.
  • The VERDICT trial demonstrates the clinical utility of CTA in managing NSTEACS.
Abstract

Keywords:
acute coronary syndromeangiographycardiac computed tomographyprognosisrisk stratification

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