Coronary Computed Tomography Versus Invasive Angiography for Non-ST Elevation Acute Coronary Syndrome

Team-based Interventional Triage in Acute Coronary Syndrome Based on Non-Invasive Computed Tomography Coronary Angiography - a Randomized Trial

Coronary computed tomography angiography (CCTA) is a widely accepted initial diagnostic test for individuals suspected of having chronic coronary syndromes. However, there is limited evidence supporting its use in the acute setting. So far, no large-scale randomized trial has examined the performance of CCTA as an alternative to invasive coronary angiography (ICA) in individuals with non-ST-segment elevation myocardial infarction (NSTEACS).

If CCTA were to replace ICA as a routine procedure for individuals with NSTEACS, it could reduce the risk of complications related to ICA, improve patient comfort, expedite decision-making, and reduce healthcare expenses and interhospital transfers.

Inclusion criteria:

• Admitted with non-ST-segment elevation myocardial infarction or unstable angina pectoris and an indication for subacute ICA
• Elevated troponin or ischemic electrocardiographic changes
• Written informed consent

Exclusion criteria:

• Instability requiring acute or emergent ICA
• History of percutaneous coronary intervention or coronary artery bypass grafting
• Estimated glomerular filtration rate < 30 mL/min/1.73m2
• Probable type 2 acute myocardial infarction
• Severe valvular heart disease as primary diagnosis or potential need for valve intervention
• History of spontaneous coronary artery dissection
• Expected poor quality of the CCTA
• Prior CCTA or ICA during index admission or within 1 week
• Known allergy to beta-blockers or contrast agent
• Pregnant or nursing
• Previously randomized in this trial