Coronary CT Angiography in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome.
J Am Coll Cardiol
; 75(5): 453-463, 2020 02 11.
Article
en En
| MEDLINE
| ID: mdl-32029126
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 11 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.Palabras clave
Texto completo:
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Banco de datos:
MEDLINE
Asunto principal:
Angiografía Coronaria
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Estenosis Coronaria
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Síndrome Coronario Agudo
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Angiografía por Tomografía Computarizada
Tipo de estudio:
Clinical_trials
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Am Coll Cardiol
Año:
2020
Tipo del documento:
Article
País de afiliación:
Dinamarca