Coronary computed tomography angiography for the assessment of SYNTAX score

Abstract

A b s t r a c tBackground: Coronary computed tomography angiography (CCTA) is applied in a growing number of clinical indications. This imaging modality is often regarded as a surrogate of invasive coronary angiography (ICA). In this paper we evaluate the applicability of CCTA alone in the assessment of the SYNTAX score. Aim:To evaluate the feasibility of calculating the SYNTAX score (SXScore) using CCTA alone instead of ICA.Methods: Ninety consecutive patients with multivessel or left main (LM) coronary artery disease diagnosed with ICA, in whom prior CCTA scan was available, were included in a post-hoc analysis. First, the SXScore was calculated twice in ten-week intervals by two experienced observers using ICA for each patient. Then the SXScore was calculated twice using CCTA following the same regimen for each patient. Weighted kappa statistic was used to assess the intra-modality and inter-modality reproducibility of the SXScore.Results: Ninety patients, aged 63.8 ± 8.9 years, 60% male, 64.4% with two-vessel disease, and 35.6% with three-vessel or LM disease met the inclusion criteria. 287 lesions were identified by ICA and 280 by CCTA (p = 0.56). Median total SXScore was 11.5 (10.2-14.0) as calculated by ) by CCTA (p < 0.001), and the results were moderately correlated (R = 0.38). Inter-modality agreement between ICA and CCTA for SXScore tertiles was moderate (kappa = 0.40). The intra-modality reproducibility of ICA and CCTA for SXScore tertiles was 0.47 and 0.51, respectively. Conclusions:Inter-modality agreement between CCTA and ICA for calculation of SXSscore is moderate but only slightly worse than intra-modality reproducibility for angiographic alone evaluation. Most of the observed variability can be assigned to the characteristic of the SXScore itself, not to the choice of imaging method. However, the application of CCTA for the assessment of SXScore should be used cautiously.

Integration of non-invasive functional assessments with anatomical risk stratification in complex coronary artery disease: the non-invasive functional SYNTAX score

“…The coronary CTA-derived SYNTAX score has been evaluated in several studies with ICA as a reference. Overall, seven studies comprising n=1,100 patients have been published (14,15,(21)(22)(23)(24)(25). A high correlation between coronary CTA and the ICA-derived SYNTAX score was found.…”

“…The SYNTAX has shown to correlate with major adverse cardiovascular events [MACE (all-cause death, myocardial infarction, stroke and target vessel revascularization)] rates after PCI. In the SYNTAX trial, MACE rates increased progressively according to the SYNTAX score tertiles, i.e., for the low SYNTAX score [0-22] 14.5% events rate, medium score group [23][24][25][26][27][28][29][30][31][32] 16.7% events rate and high score group [>32] 23.4% (12). Interestingly, in the CABG arm of the trial, no impact of the SYNTAX score on the MACE rate was observed.…”

Commentary to the article “Coronary computed tomography angiography for the assessment of SYNTAX score”

“…The authors found that coronary computed tomography angiography (CCTA) had a good reliability in detection of significant coronary lesions and assessment of SYNTAX score, showing a good correlation with the results of invasive coronary angiography [1]. The study is well written, and the authors should be congratulated for their results.…”

“…We read with great interest the article written by Wolny et al "Coronary computed tomography angiography for the assessment of SYNTAX score", which was recently published in "Kardiologia Polska" (doi 10.5603/KP.a2015.0135) [1].…”