Coronary CT angiography is a safe gatekeeper in non-ST-elevation acute coronary syndrome - The VECTOR study.

Purpose: In patients with non-ST-segment elevation acute coronary syndrome (NSTEACS), coronary pathology ranges from normal vessels to severe obstructive disease. In NSTEACS patients where invasive coronary angiography (ICA) is recommended, it is unknown whether a non-invasive coronary computed tomography angiography (CCTA) may be used for patient triage. The Very Early Computerized Tomography to Organize Revascularization in patients with NSTEACS (VECTOR) study was a pilot study that assessed whether CCTA can be used to safely discharge NSTEACS patients without obstructive coronary artery disease.

Methods: An initial CCTA categorized all patients into CCTA groups: CT, (without stenosis ≥ 50%) who avoided ICA, and CT or CT, who had ICA performed immediately after CCTA. All patients were followed for 12 months. The subsequent safety endpoints were recorded: death, nonfatal myocardial infarction, ischemia-driven revascularization, and development of renal failure.

Results: We prospectively included 250 patients, among which 193 (77%) had elevated troponins, and 81 (32%) had dynamic ECG-changes. All 51 (20%) CT patients could be discharged without ICA with an outcome free 12-month follow-up. In 175 (70%) CT patients in whom significant coronary disease was confirmed by ICA in 141 (81%), and 126 (89%) of these were revascularized. In 25% of CT patients CCTA could help guide PCI by reducing the ICA radiation dose, invasive equipment and ICA contrast volume. No patients developed renal failure.

Conclusion: In patients with NSTEACS, CCTA allows to avoid ICA in 1 of 5 patient and may guide efficient patient triage and planning of revascularization.