The usefulness of cardiac CT integrated with FFRCT for planning myocardial revascularization in complex coronary artery disease: a lesson from SYNTAX studies

Abstract

After two decades of clinical use, during which coronary CT angiography (CCTA) was considered an appropriate method for the non-invasive assessment of patients with suspected stable coronary artery disease (CAD) and low-to-intermediate pretest likelihood of CAD, a growing body of literature is showing that CCTA may have also a clinical role in patients with high pretest likelihood of CAD, known CAD and complex and diffuse CAD. Particularly, the SYNTAX studies demonstrated the usefulness of CCTA in the field of non-invasive assessment of these patients and planning of interventional and surgical coronary procedures, thanks to its ability to combine, in a single method, precise stenosis quantification, accurate plaque characterization, functional assessment and selection of the revascularization modality for any individual patient and of the vessels that need to be revascularized. Of note, the SYNTAX III Revolution trial showed, in patients with three-vessel CAD, that treatment decision-making between PCI and CABG based on CCTA only has an almost perfect agreement with the treatment decision derived from invasive coronary angiography (ICA). Moreover, the SYNTAX Score II demonstrated a high degree of correlation between the two diagnostic strategies, suggesting the potential feasibility of a treatment decision-making based solely on non-invasive imaging and clinical information. New research prospects have opened up for the future to demonstrate the true feasibility and safety of this innovative approach in the clinical arena.

A nomogram model for predicting intramyocardial hemorrhage post-PCI based on SYNTAX score and clinical features

“…The SS is primarily based on the location, type, and number of coronary artery lesions, providing robust theoretical support for the choice between PCI and Coronary Artery Bypass Grafting (CABG) [ 31 , 32 ]. Studies have demonstrated that SS can predict the prognosis of patients undergoing PCI or CABG, offering a significant theoretical basis for evaluating the severity and prognosis of coronary heart disease [ 33 ]. High-sensitivity Troponin T (HS-TnT) is a highly specific biomarker for myocardial injury assessment [ 34 ].…”

Prediction of side branch occlusion in bifurcational lesions during percutaneous coronary interventions by preprocedural coronary computed tomography using the CT bifurcation score

“…The evaluation and risk classification of individuals who come with chest discomfort is now its primary purpose. While this is undoubtedly the most prevalent utilization of this technique, it may also be a useful complement in other contexts, including plaque evaluation, coronary artery stenosis functional evaluation, and complicated intervention planning [ 13 ].…”

Is it the Time to Move Towards Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve Guided Percutaneous Coronary Intervention? The Pros and Cons

“…The first study that addressed the safety and feasibility of using CCTA-FFR alone for treatment decision-making was the FASTTRACK CABG trial (2020), which evaluated the use of CCTA-FFR for planning surgical revascularization in patients with complex coronary artery disease; the surgeons reported that this modality was safely applicable for management of patients without ICA in 84% of cases [ 107 ]. In addition to the confirmed usefulness of CCTA-FFR in diagnosing and managing CAD, compared with ICA-FFR [ 108 ], other advantages have also been elaborated for this novel method, including reduced cost and improved patients’ quality of life [ 109 , 110 ]. Nevertheless, this method is also not exempt from limitations, elaborated further below.…”