In patients with suspected ACS, obstructive atherosclerosis in the left main artery on CCTA was strongly associated with a higher incidence of MACE (aHR 18.31, p=0.004).
Cohort (n=198)
Do CCTA findings predict major adverse cardiovascular events in patients with suspected acute coronary syndrome evaluated in the emergency department?
In patients with suspected ACS in the ED, CCTA findings, including obstructive atherosclerosis and high-risk plaque, are strongly associated with future major adverse cardiovascular events and can aid in risk stratification.
Hazard Ratio: 18.31
p-value: p=0.004
Suspected acute coronary syndrome (ACS) is one of the most common reasons for urgent cardiology evaluation in the emergency department (ED). This study aimed to evaluate the characteristics and outcomes of patients with suspected ACS who were referred for coronary computed tomography angiography (CCTA) in the ED. We retrospectively enrolled consecutive patients who underwent cardiology assessment and CCTA for suspected ACS in the ED from January 2020 through December 2022. The primary endpoint was a composite of major adverse cardiovascular events (MACE) including all-cause death, acute myocardial infarction, or myocardial revascularization. The study included 198 patients, of whom 175 (51% male) had available follow-up data. Elevated high-sensitivity cardiac troponin I (hs-cTnI) was detected in 42% of patients. Compared to those with normal hs-cTnI, patients with elevated hs-cTnI showed a higher prevalence of atrial fibrillation (12% vs 1%; p < 0.001), paroxysmal supraventricular tachycardia (10% vs 0%; p < 0.001), and pericardial effusion (10% vs 2%; p = 0.023), and were more frequently referred for cardiovascular magnetic resonance (19% vs 4%; p < 0.001). Over a median follow-up of 28 months (IQR:18–34), 14 patients (8%) reached the composite endpoint. After adjusting for demographics, ECG data, and hs-cTnI levels, obstructive atherosclerosis in left main (aHR = 18.31, p = 0.004), circumflex (Cx) (aHR = 8.54, p = 0.008), right coronary artery (aHR = 5.22, p = 0.028), moderate atherosclerosis in the left anterior descending artery (aHR = 6.88, p = 0.039) and mild irregularities in the Cx (aHR = 5.86, p = 0.043) were associated with a higher incidence of MACE. Both the presence of high-risk plaque and higher CAD-RADS 2.0 categories were associated with an increased likelihood of in-hospital revascularization and a survival tree model incorporating myocardial injury markers and CCTA findings demonstrated potential utility for risk stratification. In patients with suspected ACS undergoing cardiology assessment in the ED, CCTA may support patient management. Graphical abstract AF: atrial fibrillation; CAD: coronary artery disease; CCTA: coronary computed tomography angiography; CMR: cardiovascular magnetic resonance; DAPT: dual antiplatelet therapy; ED: emergency department; LAD: left anterior descending artery; SVT: supraventricular tachycardia
Ciliberti et al. (2026) conducted a cohort in Suspected acute coronary syndrome (n=198). Obstructive atherosclerosis in the left main artery on CCTA vs. Absence of obstructive atherosclerosis was evaluated on Composite of major adverse cardiovascular events (MACE) including all-cause death, acute myocardial infarction, or myocardial revascularization (aHR 18.31, p=0.004). In patients with suspected ACS, obstructive atherosclerosis in the left main artery on CCTA was strongly associated with a higher incidence of MACE (aHR 18.31, p=0.004).