Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Radiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
J Am Coll Cardiol. 2021 Mar 2;77(8):1044-1052. doi: 10.1016/j.jacc.2020.12.037.
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).
This study tested the hypothesis that coronary computed tomography angiography (CTA) is equivalent to ICA for risk assessment in patients with NSTEACS.
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.
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).
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).
通过有创冠状动脉造影（ICA）评估的冠状动脉疾病（CAD）的严重程度和范围可指导治疗，并可预测非 ST 段抬高型急性冠状动脉综合征（NSTEACS）患者的临床结局。
本研究检验了冠状动脉计算机断层扫描血管造影（CTA）在 NSTEACS 患者风险评估中与 ICA 等效的假设。
VERDICT（急性冠状动脉综合征患者使用计算机断层扫描早期与延迟有创评估试验）评估了 NSTEACS 患者治疗时机与结局之间的关系，包括在 ICA 之前进行的临床盲法冠状动脉 CTA。CAD 的严重程度定义为阻塞性（冠状动脉狭窄≥50%）或非阻塞性。CAD 的范围定义为高危（阻塞性左主干或近端左前降支狭窄和/或多支血管疾病）或非高危。主要终点是全因死亡、非致死性复发性心肌梗死、因难治性心肌缺血住院或心力衰竭。
978 例患者进行了冠状动脉 CTA 和 ICA。在中位随访时间 4.2 年（四分位间距：2.7 至 5.5 年）期间，208 例患者（21.3%）发生了主要终点事件。与冠状动脉 CTA 定义的非阻塞性 CAD 患者相比，阻塞性 CAD 患者的主要终点发生率高达 1.7 倍（风险比[HR]：1.74；95%置信区间[CI]：1.22 至 2.49；p=0.002）或 ICA（HR：1.54；95%CI：1.13 至 2.11；p=0.007）。在高危 CAD 患者中，与冠状动脉 CTA 定义的非高危 CAD 患者相比，主要终点事件发生率高 1.5 倍（HR：1.56；95%CI：1.18 至 2.07；p=0.002）。ICA 也有类似的趋势（HR：1.28；95%CI：0.98 至 1.69；p=0.07）。
在 NSTEACS 患者中，冠状动脉 CTA 与 ICA 评估长期风险相当。（急性冠状动脉综合征患者使用计算机断层扫描早期与延迟有创评估试验[VERDICT]；NCT02061891）。
