Value of upfront coronary computed tomography angiography in patients with non-ST-segment elevation acute coronary syndrome.

This study aimed to evaluate the diagnostic performance of coronary computed tomography angiography (CCTA) in ruling out coronary artery stenosis ≥ 70% across all segments and its role in providing preprocedural guidance for chronic total occlusion (CTO) management in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). This study was a post hoc analysis of a prospective, multicenter cohort comprising 347 patients with NSTE-ACS. All patients underwent CCTA immediately after being diagnosed with NSTE-ACS, followed by invasive coronary angiography (ICA) within 1 day. The diagnostic performance of CCTA in ruling out obstructive coronary stenosis was assessed using negative predictive value (NPV). Additionally, segments distal to CTO were analyzed to compare the detection capabilities of CCTA and ICA. The NPV of CCTA for ruling out coronary stenosis ≥ 70% was robust, ranging from 94.7 to 100.0% across the 18-segment model at the segment level, and 25.9% of patients had no significant stenosis and could have avoided unnecessary ICA based on CCTA findings. CCTA identified 71.0% of segments distal to CTO, significantly higher than ICA (48.8%, P < 0.001). 25.1% of patients had CTO, where CCTA provided valuable preprocedural guidance for revascularization. CCTA demonstrated high diagnostic accuracy in ruling out significant stenosis and provided critical information for CTO revascularization, highlighting its potential as a triaging and planning tool in NSTE-ACS.