Prognostic Value of Coronary CT Angiography in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes
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Prognostic Value of Coronary CT Angiography in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes. / Kofoed, Klaus F.; Engstrøm, Thomas; Sigvardsen, Per E.; Linde, Jesper J.; Torp-Pedersen, Christian; de Knegt, Martina; Hansen, Peter R.; Fritz-Hansen, Thomas; Bech, Jan; Heitmann, Merete; Nielsen, Olav W.; Høfsten, Dan; Kühl, Jørgen T.; Raymond, Ilan E.; Kristiansen, Ole P.; Svendsen, Ida H.; Domínguez Vall-Lamora, M. H.; Kragelund, Charlotte; Hove, Jens D.; Jørgensen, Tem; Fornitz, Gitte G.; Steffensen, Rolf; Jurlander, Birgit; Abdulla, Jawdat; Lyngbæk, Stig; Elming, Hanne; Therkelsen, Susette K.; Jørgensen, Erik; Kløvgaard, Lene; Bang, Lia E.; Helqvist, Steffen; Galatius, Søren; Pedersen, Frants; Abildgaard, Ulrik; Clemmensen, Peter; Saunamäki, Kari; Holmvang, Lene; Gislason, Gunnar; Kelbæk, Henning; Køber, Lars V.
In: Journal of the American College of Cardiology, Vol. 77, No. 8, 02.03.2021, p. 1044-1052.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Prognostic Value of Coronary CT Angiography in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes
AU - Kofoed, Klaus F.
AU - Engstrøm, Thomas
AU - Sigvardsen, Per E.
AU - Linde, Jesper J.
AU - Torp-Pedersen, Christian
AU - de Knegt, Martina
AU - Hansen, Peter R.
AU - Fritz-Hansen, Thomas
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 - Domínguez Vall-Lamora, M. H.
AU - Kragelund, Charlotte
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 E.
AU - Helqvist, Steffen
AU - Galatius, Søren
AU - Pedersen, Frants
AU - Abildgaard, Ulrik
AU - Clemmensen, Peter
AU - Saunamäki, Kari
AU - Holmvang, Lene
AU - Gislason, Gunnar
AU - Kelbæk, Henning
AU - Køber, Lars V.
N1 - Publisher Copyright: © 2021 American College of Cardiology Foundation
PY - 2021/3/2
Y1 - 2021/3/2
N2 - 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)
AB - 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)
KW - acute coronary syndrome
KW - angiography
KW - cardiac computed tomography
KW - prognosis
KW - risk stratification
U2 - 10.1016/j.jacc.2020.12.037
DO - 10.1016/j.jacc.2020.12.037
M3 - Journal article
C2 - 33632478
AN - SCOPUS:85101040952
VL - 77
SP - 1044
EP - 1052
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 8
ER -
ID: 285725705