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: J AM COLL CARDIOL, Jahrgang 77, Nr. 8, 02.03.2021, S. 1044-1052.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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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 - Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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/epidemiology
KW - Aged
KW - Computed Tomography Angiography
KW - Coronary Stenosis/diagnostic imaging
KW - Female
KW - Heart Failure/epidemiology
KW - Humans
KW - Male
KW - Myocardial Infarction/epidemiology
KW - Myocardial Ischemia/epidemiology
KW - Prognosis
KW - Risk Assessment
KW - Severity of Illness Index
U2 - 10.1016/j.jacc.2020.12.037
DO - 10.1016/j.jacc.2020.12.037
M3 - SCORING: Journal article
C2 - 33632478
VL - 77
SP - 1044
EP - 1052
JO - J AM COLL CARDIOL
JF - J AM COLL CARDIOL
SN - 0735-1097
IS - 8
ER -