Coronary computed tomography angiography (CTA) provides value comparable to invasive coronary angiography (ICA) as a treatment option for patients with non–ST-elevation acute coronary syndromes (NSTE-ACS), according to a new analysis of nearly 1,000 patients. This suggests that CTA may give healthcare providers a simple, effective, noninvasive alternative to catheter-based ICA.
The findings, published in the Journal of the American College of Cardiology, are based on a new assessment of data from the VERDICT trial.
“Severity of coronary pathology defined by nonobstructive versus obstructive disease and the extent of coronary artery disease (CAD) in the vascular tree are considered important angiographic guides to the risk-benefit ratio of coronary revascularization and provides assessment of the overall long-term risk of patients with NSTE-ACS,” wrote first author Klaus F. Kofoed, MD, PhD, DmSc, a cardiologist at the University of Copenhagen in Denmark, and colleagues. “Nevertheless, a routine invasive strategy is associated with an increased risk of bleeding and prolonged hospital stay and may not provide long-term benefits to all patients with NSTEACS.”
For this study, coronary CTA was performed on a total of 978 patients at one of nine hospitals in Denmark. Each patient also underwent blinded coronary CTA prior to ICA. Participants were randomly chosen to either undergo an invasive strategy within 12 hours or a deferred invasive strategy within 48 to 72 hours. The median follow-up time was 4.2 years.
Overall, obstructive CAD was identified in 73% of patients by CTA and 67% of patients by ICA. High-risk CAD, meanwhile, was identified in 51% of patients by CTA and 36.8% by ICA. CAD and ICA findings were in agreement in 76.8% of all patients.
Also, the team added, “subsequent ICA in patients with nonobstructive CAD by coronary CTA or vice versa did not provide further risk stratification.”
“Severity and extent of CAD as defined by coronary CTA are equivalent to corresponding measures defined by ICA for the assessment of long-term risk in patients with NSTE-ACS,” the authors concluded.
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