Early coronary CT angiography (CTA) can accurately exclude coronary stenosis in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS).

The negative predictive value of CTA to rule out coronary artery stenosis of at least 50% was found to be 90.9% (95% CI, 86.8% - 94.1%). Most false-negative results were noted in those who had a single stenosis in small side branches with a luminal diameter of <2.5 mm. The positive predictive value of CTA was 87.9%, with sensitivity being 96.5%, and specificity of 72.4%.

VERDICT, the largest CTA study in NSTEACS until this day, was published in the February 11 issue of Journal of the American College of Cardiology. According to the trial, among patients with NSTEACS, coronary CTA can be conducted within 2 hours of clinical diagnosis to quickly identify patients in whom invasive evaluation will be ineffective.

Currently, the guidelines back invasive angiography as the primary diagnostic tool for patients with ACS, and coronary CTA is reserved for those with chest pain who have an intermediate pre-test likelihood of CAD. The recommendations are based on early moderately sized ACS studies using 64-row CT in low-risk cohorts. VERDICT included high-risk patients, and most of them were evaluated using 320-detector CT.

VERDICT investigators had previously reported that very early angiography within 12 hours of NSTEACS diagnosis did not improve 5-year clinical outcomes in comparison with standard angiography within 48 to 72 hours.

Dr KK Aggarwal,

President CMAAO, HCFI and Past National President IMA