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

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

doi:10.1016/j.jacc.2019.12.012

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

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 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

132 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 language	English
Journal	Journal of the American College of Cardiology
Volume	75
Issue number	5
Pages (from-to)	453-463
Number of pages	11
ISSN	0735-1097
DOIs	https://doi.org/10.1016/j.jacc.2019.12.012
Publication status	Published - 11 Feb 2020

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10.1016/j.jacc.2019.12.012

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Linde, J. J., Kelbæk, H., Hansen, T. F., Sigvardsen, P. E., Torp-Pedersen, C., Bech, J., Heitmann, M., Nielsen, O. W., Høfsten, D., Kühl, J. T., Raymond, I. E., Kristiansen, O. P., Svendsen, I. H., Vall-Lamora, M. H. D., Kragelund, C., de Knegt, M., Hove, J. D., Jørgensen, T., Fornitz, G. G., ... Kofoed, K. F. (2020). Coronary CT Angiography in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome. Journal of the American College of Cardiology, 75(5), 453-463. https://doi.org/10.1016/j.jacc.2019.12.012

Linde, JJ, Kelbæk, H, Hansen, TF , Sigvardsen, PE , Torp-Pedersen, C , Bech, J , Heitmann, M , Nielsen, OW , Høfsten, D, Kühl, JT, Raymond, IE, Kristiansen, OP , Svendsen, IH , Vall-Lamora, MHD , Kragelund, C, de Knegt, M, Hove, JD , Jørgensen, T , Fornitz, GG , Steffensen, R , Jurlander, B , Abdulla, J , Lyngbæk, S, Elming, H, Therkelsen, SK, Jørgensen, E , Kløvgaard, L , Bang, LE , Hansen, PR , Helqvist, S , Galatius, S , Pedersen, F, Abildgaard, U, Clemmensen, P, Saunamäki, K, Holmvang, L , Engstrøm, T , Gislason, G , Køber, LV & Kofoed, KF 2020, 'Coronary CT Angiography in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome', Journal of the American College of Cardiology, vol. 75, no. 5, pp. 453-463. https://doi.org/10.1016/j.jacc.2019.12.012

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title = "Coronary CT Angiography in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome",

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.",

author = "Linde, {Jesper J} and Henning Kelb{\ae}k and Hansen, {Thomas F} and Sigvardsen, {Per E} and Christian Torp-Pedersen and Jan Bech and Merete Heitmann and Nielsen, {Olav W} and Dan H{\o}fsten and K{\"u}hl, {J{\o}rgen T} and Raymond, {Ilan E} and Kristiansen, {Ole P} and Svendsen, {Ida H} and Vall-Lamora, {Maria H D} and Charlotte Kragelund and {de Knegt}, Martina and Hove, {Jens D} and Tem J{\o}rgensen and Fornitz, {Gitte G} and Rolf Steffensen and Birgit Jurlander and Jawdat Abdulla and Stig Lyngb{\ae}k and Hanne Elming and Therkelsen, {Susette K} and Erik J{\o}rgensen and Lene Kl{\o}vgaard and Bang, {Lia Evi} and Hansen, {Peter Riis} and Steffen Helqvist and S{\o}ren Galatius and Frants Pedersen and Ulrik Abildgaard and Peter Clemmensen and Kari Saunam{\"a}ki and Lene Holmvang and Thomas Engstr{\o}m and Gunnar Gislason and K{\o}ber, {Lars V} and Kofoed, {Klaus F}",

year = "2020",

month = feb,

day = "11",

doi = "10.1016/j.jacc.2019.12.012",

language = "English",

volume = "75",

pages = "453--463",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier Inc",

number = "5",

}

TY - JOUR

T1 - Coronary CT Angiography in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome

AU - Linde, Jesper J

AU - Kelbæk, Henning

AU - Hansen, Thomas F

AU - Sigvardsen, Per E

AU - Torp-Pedersen, Christian

AU - Bech, Jan

AU - Heitmann, Merete

AU - Nielsen, Olav W

AU - Høfsten, Dan

AU - Kühl, Jørgen T

AU - Raymond, Ilan E

AU - Kristiansen, Ole P

AU - Svendsen, Ida H

AU - Vall-Lamora, Maria H D

AU - Kragelund, Charlotte

AU - de Knegt, Martina

AU - Hove, Jens D

AU - Jørgensen, Tem

AU - Fornitz, Gitte G

AU - Steffensen, Rolf

AU - Jurlander, Birgit

AU - Abdulla, Jawdat

AU - Lyngbæk, Stig

AU - Elming, Hanne

AU - Therkelsen, Susette K

AU - Jørgensen, Erik

AU - Kløvgaard, Lene

AU - Bang, Lia Evi

AU - Hansen, Peter Riis

AU - Helqvist, Steffen

AU - Galatius, Søren

AU - Pedersen, Frants

AU - Abildgaard, Ulrik

AU - Clemmensen, Peter

AU - Saunamäki, Kari

AU - Holmvang, Lene

AU - Engstrøm, Thomas

AU - Gislason, Gunnar

AU - Køber, Lars V

AU - Kofoed, Klaus F

PY - 2020/2/11

Y1 - 2020/2/11

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85078263838&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2019.12.012

DO - 10.1016/j.jacc.2019.12.012

M3 - Journal article

C2 - 32029126

SN - 0735-1097

VL - 75

SP - 453

EP - 463

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 5

ER -

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

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