Match!

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

Published on Feb 11, 2020in Journal of the American College of Cardiology18.639
· DOI :10.1016/J.JACC.2019.12.012
Jesper J. Linde9
Estimated H-index: 9
(UCPH: University of Copenhagen),
Henning Kelbæk35
Estimated H-index: 35
+ 37 AuthorsJørgen Tobias Kühl10
Estimated H-index: 10
Abstract
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.
  • References (23)
  • Citations (1)
📖 Papers frequently viewed together
11 Citations
29 Citations
32 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
References23
Newest
#1Juhani KnuutiH-Index: 85
#2William WijnsH-Index: 102
Last. Thomas CuissetH-Index: 46
view all 25 authors...
Coronary artery disease (CAD) is a pathological process characterized by atherosclerotic plaque accumulation in the epicardial arteries, whether obstructive or non-obstructive. This process can be modified by lifestyle adjustments, pharmacological therapies, and invasive interventions designed to achieve disease stabilization or regression. The disease can have long, stable periods but can also become unstable at any time, typically due to an acute atherothrombotic event caused by plaque rupture...
143 CitationsSource
#1Franz-Josef NeumannH-Index: 20
#2Miguel Sousa UvaH-Index: 35
Last. Robert A. HendersonH-Index: 23
view all 127 authors...
387 CitationsSource
#1Kevin P LiouH-Index: 1
#2Sze-Yuan OoiH-Index: 8
Last. Nick E.J. West (Papworth Hospital)H-Index: 42
view all 4 authors...
Background The utility of fractional flow reserve (FFR) to guide revascularisation in the management of acute coronary syndrome (ACS) remains unclear. Objective This study aims to compare the clinical outcomes of patients following FFR-guided revascularisation for either ACS or stable angina (SA) and in particular focuses on the outcome of those with deferred revascularisation after FFR. Methods A meta-analysis of existing literature was performed. Outcomes including the rate of major adverse ca...
1 CitationsSource
#1Klaus F. Kofoed (UCPH: University of Copenhagen)H-Index: 30
#2Henning KelbækH-Index: 35
Last. Thomas Engstrøm (UCPH: University of Copenhagen)H-Index: 38
view all 38 authors...
Background: The optimal timing of invasive coronary angiography (ICA) and revascularization in patients with non-ST-segment elevation acute coronary syndrome is not well defined. We tested the hypo...
18 CitationsSource
#1Sock Keow Tan (UM: University of Malaya)H-Index: 3
#2Chai Hong Yeong (UM: University of Malaya)H-Index: 8
Last. Zhonghua Sun (Curtin University)H-Index: 29
view all 7 authors...
Objective:This study aimed (1) to perform a systematic review on scanning parameters and contrast medium (CM) reduction methods used in prospectively ECG-triggered low tube voltage coronary CT angiography (CCTA), (2) to compare the achievable dose reduction and image quality, and (3) to propose appropriate scanning techniques and CM administration methods.Methods:A systematic search were performed in PubMed, the Cochrane library, CINAHL, Web of Science, ScienceDirect and Scopus, where 20 studies...
6 CitationsSource
#1J. Tobias Kühl (UCPH: University of Copenhagen)H-Index: 8
#2Jens D. Hove (UCPH: University of Copenhagen)H-Index: 13
Last. Klaus F. Kofoed (UCPH: University of Copenhagen)H-Index: 30
view all 8 authors...
AbstractObjectives. To test if cardiac computed tomography angiography (CCTA) can be used in the triage of patients at high risk of coronary artery disease. Design. The diagnostic value of 64-detector CCTA was evaluated in 400 patients presenting with non-ST segment elevation myocardial infarction using invasive coronary angiography (ICA) as the reference method. The relation between the severity of disease by CCTA and a combined endpoint of death, re-hospitalization due to new myocardial infarc...
6 CitationsSource
#1Chuan ZhouH-Index: 26
#2Heang Ping ChanH-Index: 56
Last. Ella A. KazerooniH-Index: 68
view all 6 authors...
1,517 CitationsSource
#1Jonathon P. Fanning (UQ: University of Queensland)H-Index: 9
#2Jonathan NyongH-Index: 4
view all 5 authors...
Background People with unstable angina and non-ST elevation myocardial infarction (UA/NSTEMI) are managed with a combination of medical therapy, invasive angiography and revascularisation. Specifically, two approaches have evolved: either a 'routine invasive' strategy whereby all patients undergo coronary angiography shortly after admission and, if indicated, coronary revascularisation; or a 'selective invasive' (also referred to as 'conservative') strategy in which medical therapy alone is used...
15 CitationsSource
#1P. M. M. Bossuyt (UvA: University of Amsterdam)H-Index: 110
#2JohannesBReitsma (UU: Utrecht University)H-Index: 59
Last. Henrica C.W. de Vet (VUmc: VU University Medical Center)H-Index: 93
view all 17 authors...
Incomplete reporting has been identified as a major source of avoidable waste in biomedical research. Essential information is often not provided in study reports, impeding the identification, critical appraisal, and replication of studies. To improve the quality of reporting of diagnostic accuracy studies, the Standards for Reporting Diagnostic Accuracy (STARD) statement was developed. Here we present STARD 2015, an updated list of 30 essential items that should be included in every report of a...
654 CitationsSource
#1Jonathon Leipsic (UBC: University of British Columbia)H-Index: 68
#2Suhny Abbara (UTSW: University of Texas Southwestern Medical Center)H-Index: 56
Last. Gilbert L. Raff (Beaumont Hospital)H-Index: 40
view all 9 authors...
282 CitationsSource
Cited By1
Newest
Source