CTA Equivalent to ICA for Identifying Long-Term Non–ST Segment Elevation ACS Risk

CAD, coronary artery disease, atherosclerosis, angiogram, angiography
CAD, coronary artery disease, atherosclerosis, angiogram, angiography
Computed tomography angiography and invasive coronary angiography may equally predict clinical outcome in patients with nonST segment elevation ACS.

Coronary computed tomography angiography (CTA) may be equivalent to invasive coronary angiography (ICA) for assessing the long-term risk in patients with non–ST segment elevation acute coronary syndrome (NSTEACS), according to study results published in the Journal of the American College of Cardiology.

The Very Early veRsus Deferred Invasive Evaluation Using Computerized Tomography in Patients With Acute Coronary Syndromes (VERDICT-EDI) trial evaluated the timing of treatment in relation to outcome among patients with NSTEACS and included a clinically blinded coronary CTA before ICA.

The researchers defined severity of CAD as obstructive (coronary stenosis ≥50%) or nonobstructive, and the extent of CAD as high-risk (obstructive left-main- or proximal left-anterior-descending artery stenosis and/or multivessel disease) or non-high risk (all other CAD not included in previous group). The primary endpoint was a composite of all-cause death, nonfatal recurrent myocardial infarction, hospital admission for refractory myocardial ischemia, or heart failure.

A total of 978 patients (mean age, 61.6±11.7 years; 66.6% male) underwent coronary CTA and ICA. In a median follow-up of 4.2 (interquartile range, 2.8-5.5) years, the primary endpoint occurred in 208 (21.3%) patients.

The rate of the primary endpoints was 1.7-fold higher among patients with obstructive CAD compared with patients with nonobstructive CAD (hazard ratio [HR], 1.74 [95% CI, 1.22-2.49]; P =.002), when patients were grouped according to the coronary CTA extent of CAD. Researchers noted similar findings when patients were grouped according to ICA (HR, 1.54 [95% CI, 1.13-2.11]; P =.007). In the subgroup of patients without an increase in troponin, they observed similar trends.

When patients were grouped according to the coronary CTA extent of obstructive CAD, the rate of the primary endpoint was almost 1.6-fold higher in patients with high-risk CAD than in patients who had nonhigh risk CAD (HR, 1.56 [95% CI, 1.18-2.07]; P =.002). Investigators observed a similar trend for ICA (HR, 1.28 [95% CI, 0.98-1.69]; P =.07).

“We found coronary CTA to be equivalent, but not identical, to ICA for the assessment of long-term risk in patients with NSTEACS,” stated the investigators. “Overall, more patients with obstructive CAD were recorded when using coronary CTA than when using ICA.”

Among several limitations of the VERDICT-EDI trial, patients with impaired renal function, known atrial fibrillation, previous coronary artery bypass graft, and women aged <45 years were not included, and not all patients underwent coronary CTA. Also, the primary endpoint was a composite of severe and less severe clinical events, and the sample size precluded analysis of individual components.

“Our findings suggest that coronary CTA has similar prognostic accuracy as ICA to identify patients with obstructive CAD associated with worsened clinical outcome,” the study authors concluded.

Disclosures: Some of the authors reported affiliations with pharmaceutical and medical equipment companies. Please see the original reference for a full list of disclosures.


Kofoed KK, Engstrøm T, Sigvardsen PE, et al. Prognostic value of coronary CT angiography in patients with non–ST-segment elevation acute coronary syndromes. J Am Coll Cardiol. 2021;77(8):1044-1052.