Computed tomography angiography or invasive coronary angiography in patients with lowto intermediate risk acute coronary syndrome — a single-center study

Aim. To evaluate the strategy of using coronary computed tomography angiography (CCTA) in patients with low-to-intermediate risk of non-ST segment elevation acute coronary syndrome (NSTE-ACS) in relation to early (in-hospital) and long-term prognosis in comparison with standard management tactics.

Material and methods. The study included 259 patients (men (M), 47,9%, mean age, 62,2±9,4 years). Patients in group 1 (n=148 people, M 46,6%, mean age 61,99±9,92 years) underwent CCTA to assess coronary involvement, and patients in group 2 (n=111 people, M 49,5%, mean age 62,4±8,6 years) — invasive coronary angiography (ICA). The follow-up lasted 18 months.

Results. Patients in both groups were comparable in age, concomitant chronic diseases and smoking. Patients in the CCTA group compared with the ICA group had lower GRACE score and lower values of high-sensitivity Troponin I. In 85 patients (57,4%) of group 1 there was no coronary involvement, while 41 patients (27,7%) had <50% stenosis, 22 patients (14,9%) — >50% stenosis in at least one coronary artery. In group 2, the majority of patients also had non-involved coronary vessels (n=76; 68,5%), while hemodynamically insignificant (20-40%) and significant lesions were detected in 20 patients (12,3%) and 15 people (13,5%), respectively. In group 1, 20 patients were referred for ICA as follows: 10 patients underwent percutaneous coronary interventions; 2 patients had multivessel disease; in 4 patients, intraoperative fractional flow reserve revealed hemodynamically insignificant stenoses; in 4 remaining patients, no significant lesions were detected. All-cause mortality was 4,05% in the CCTA group, and 7,2% in the ICA group (p=0,28). In the CCTA group, cardiovascular mortality was 0%, and in the ICA group — 0,9% (p=0,43).

Conclusion. CCTA in patients with low-to-intermediate risk ACS is not inferior to the standard tactics for managing these patients and significantly reduces the need for iCAG.

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