Author + information
- Received June 17, 2019
- Revision received December 2, 2019
- Accepted December 3, 2019
- Published online February 3, 2020.
- Jesper J. Linde, MD, PhDa,
- Henning Kelbæk, MD, DmScb,
- Thomas F. Hansen, MD, PhDc,
- Per E. Sigvardsen, MDa,
- Christian Torp-Pedersen, MD, DmScc,
- Jan Bech, MD, PhDd,
- Merete Heitmann, MD, PhDd,
- Olav W. Nielsen, MD, DmScd,
- Dan Høfsten, MD, PhDa,
- Jørgen T. Kühl, MD, DmScb,
- Ilan E. Raymond, MD, PhDd,
- Ole P. Kristiansen, MD, PhDd,
- Ida H. Svendsen, MD, PhDd,
- Maria H.D. Vall-Lamora, MD, PhDd,
- Charlotte Kragelund, MD, PhDc,
- Martina de Knegt, MD, PhDa,
- Jens D. Hove, MD, PhDe,
- Tem Jørgensen, MDe,
- Gitte G. Fornitz, MD, PhDe,
- Rolf Steffensen, MDf,
- Birgit Jurlander, MD, PhDf,
- Jawdat Abdulla, MD, PhDg,
- Stig Lyngbæk, MD, PhDg,
- Hanne Elming, MD, PhDb,
- Susette K. Therkelsen, MD, PhDb,
- Erik Jørgensen, MDa,
- Lene Kløvgaard, RNa,
- Lia Evi Bang, MD, PhDa,
- Peter Riis Hansen, MD, DmScc,
- Steffen Helqvist, MD, DmSca,
- Søren Galatius, MD, DmScc,
- Frants Pedersen, MD, PhDa,
- Ulrik Abildgaard, MD, PhDc,
- Peter Clemmensen, MD, DmSch,
- Kari Saunamäki, MD, DmScc,
- Lene Holmvang, MD, DmSca,
- Thomas Engstrøm, MD, DmSca,
- Gunnar Gislason, MD, DmScc,
- Lars V. Køber, MD, DmSca and
- Klaus F. Kofoed, MD, DmSca,∗ ( )(, )@Rigshospitalet
- aDepartment of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- bDepartment of Cardiology, Zealand University Hospital, Roskilde, Slagelse & Holbæk, Roskilde, Denmark
- cDepartment of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- dDepartment of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- eDepartment of Cardiology, Hvidovre and Amager Hospital, University of Copenhagen, Copenhagen, Denmark
- fDepartment of Cardiology, Hillerød Hospital, University of Copenhagen, Copenhagen, Denmark
- gDepartment of Cardiology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark
- hDepartment of General and Interventional Cardiology, University Heart Center Hamburg, University Clinic Hamburg-Eppendorf, Hamburg, Germany
- ↵∗Address for correspondence:
Dr. Klaus F. Kofoed, Department of Cardiology & Radiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100-CPH, Denmark.
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.
This study was funded by the Danish Agency for Science, Technology, and Innovation and the Danish Council for Strategic Research (grant no. 09–066994) and the Research Council of Rigshospitalet. Dr. Linde has received grants from the Danish Research Foundation and the Research Council of Rigshospitalet during the conduct of the study. Dr. Torp-Pedersen has received grants from Bayer outside of the submitted work; and has received a grant from Novo Nordisk for an epidemiological study. Dr. de Knegt has previously received lecturing fees from Toshiba Medical; and has received an educational grant from AstraZeneca. Dr. Abdulla has received personal fees from Novartis Healthcare outside of the submitted work. Dr. Engstrom has received personal fees from Abbott, AstraZeneca, Bayer, Boston Scientific, and Novo Nordisk outside of the submitted work. Dr. Kober has received grants from the Danish Research Foundation during the conduct of the study. Dr. Kofoed has received grants from the Danish Research Foundation during the conduct of the study; and has received grants from the Research Council of Rigshospitalet, AP Moller og hustru Chastine McKinney Mollers Fond, the Danish Heart Foundation, and Canon Medical Corporation outside of the submitted work. All other authors have reported that thy have no relationships relevant to the contents of this paper to disclose.
- Received June 17, 2019.
- Revision received December 2, 2019.
- Accepted December 3, 2019.
- 2020 American College of Cardiology Foundation
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