Table 1.
Key randomized trials of CCTA in suspected NSTE-ACS
| Trial | Population | Primary outcome | Key findings |
|---|---|---|---|
| RAPID-CTCA15 | Suspected/provisional ACS; intermediate risk (n = 1,748) | 1-year death or type 1/4b MI | No difference in MACE; reduced ICA use; modest reduction in subsequent testing, no major LOS difference |
| VERDICT8 | Confirmed NSTE-ACS (n = 1,023) | Diagnostic performance vs. ICA | High NPV for ruling out ≥50% stenosis; accurately characterized CAD distribution |
| BEACON22 | ED suspected ACS, low-intermediate risk | MACE at follow-up | No difference in MACE; shorter LOS and lower costs in low-risk patients |
| PROTECCT21 | Intermediate hs-cTn ‘observe zone’ | 12-month MACE | No change in MACE; trend to fewer downstream tests |
FIGURE 1.
CCTA demonstrating high-risk atherosclerotic plaque morphology in the left anterior descending and right coronary arteries. A. Multiplanar reconstruction of the left anterior descending artery demonstrates an eccentric, predominantly non calcified, low attenuation plaque in the proximal–mid segment, associated with positive vessel remodeling and superimposed spotty calcifications. Volume rendered 3D reconstruction confirms the extent and distribution of the lesion along the LAD. B. CCTA images illustrating high-risk plaque characteristics. Axial cross-sectional images (upper right) demonstrate the typical features of vulnerable plaque, including the napkin-ring sign, spotty calcification, and low-attenuation plaque. The 3D volume rendered reconstruction (lower left) depicts the spatial relationship of the high-risk plaque within the coronary anatomy.
FIGURE 2.
Automated coronary plaque quantification and stenosis assessment using CCTA post-processing software. A. Serial crosssectional images along the lesion, with automated luminal (inner contour) and vessel (outer contour) segmentation enabling precise assessment of plaque burden and vessel remodeling. B. Multiplanar reconstruction views of the affected coronary segment with software-derived measurements indicating a 62% area stenosis and 64% diameter stenosis over a lesion length of 22.9 mm, consistent with hemodynamically significant obstructive CAD as defined by contemporary CCTA criteria.