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

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:77

Article

Kofoed, Klaus F.^1,2  Engstrom, Thomas¹  Sigvardsen, Per E.¹  Linde, Jesper J.¹  Torp-Pedersen, Christian³  de Knegt, Martina¹  Hansen, Peter R.³  Fritz-Hansen, Thomas³  Bech, Jan⁴  Heitmann, Merete⁴  Nielsen, Olav W.⁴  Hofsten, Dan¹  Kuhl, Jorgen T.^5,6,7  Raymond, Ilan E.^5,6,7  Kristiansen, Ole P.⁴  Svendsen, Ida H.⁴  Vall-Lamora, M. H. Dominguez⁴  Kragelund, Charlotte³  Hove, Jens D.⁸  Jorgensen, Tem⁸  Fornitz, Gitte G.⁸  Steffensen, Rolf⁹  Jurlander, Birgit⁹  Abdulla, Jawdat⁸  Lyngbaek, Stig¹⁰  Elming, Hanne^5,6,7  Therkelsen, Susette K.^5,6,7  Jorgensen, Erik¹  Klovgaard, Lene¹  Bang, Lia E.¹  Helqvist, Steffen¹  Galatius, Soren³  Pedersen, Frants¹  Abildgaard, Ulrik³  Clemmensen, Peter^11,12  Saunamaki, Kari³  Holmvang, Lene¹  Gislason, Gunnar³  Kelbaek, Henning^5,6,7  Kober, Lars, V¹ 

[1] Univ Copenhagen, Rigshosp, Dept Cardiol, Blegdamsvej 9, DK-2100 Copenhagen, Denmark

[2] Univ Copenhagen, Rigshosp, Dept Radiol, Blegdamsvej 9, DK-2100 Copenhagen, Denmark

[3] Univ Copenhagen, Herlev Gentofte Hosp, Dept Cardiol, Copenhagen, Denmark

[4] Univ Copenhagen, Bispebjerg & Frederiksberg Hosp, Dept Cardiol, Copenhagen, Denmark

[5] Zealand Univ Hosp, Dept Cardiol, Roskilde, Denmark

[6] Zealand Univ Hosp, Dept Cardiol, Slagelse, Denmark

[7] Zealand Univ Hosp, Dept Cardiol, Holbaek, Denmark

[8] Univ Copenhagen, Hvidovre & Amager Hosp, Dept Cardiol, Copenhagen, Denmark

[9] Univ Copenhagen, Hillerd Hosp, Dept Cardiol, Copenhagen, Denmark

[10] Univ Copenhagen, Glostrup Hosp, Dept Cardiol, Copenhagen, Denmark

[11] Univ Clin Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Dept Cardiol, Hamburg, Germany

[12] Univ Southern Denmark, Nykoebing F Hosp, Inst Reg Hlth Res, Dept Med, Odense, Denmark

关键词: acute coronary syndrome;    angiography;    cardiac computed tomography;    risk stratification;    prognosis;   

DOI  :  10.1016/j.jacc.2020.12.037

来源: Elsevier

【 摘 要 】

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 (inter quartile 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)

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