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Bispebjerg Hospital - a part of Copenhagen University Hospital
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Coronary CT Angiography in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome

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  • Jesper J Linde
  • Henning Kelbæk
  • Thomas F Hansen
  • Per E Sigvardsen
  • Christian 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 Steffensen
  • Birgit 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
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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
Number of pages11
ISSN0735-1097
DOIs
Publication statusPublished - 11 Feb 2020

ID: 59268424