Highlights
SYNTAX score commonly assesses coronary artery disease complexity by invasive coronary angiography (ICA).
SYNTAX scores derived from coronary computed tomography angiography (CCTA) are concordant with those derived from ICA.
CCTA- and ICA-derived SYNTAX scores correlate with complexity of percutaneous coronary intervention.
Derivation of SYNTAX score by CCTA might assist in percutaneous coronary intervention planning.
Rationale and Objectives
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Materials and Methods
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Results
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Conclusion
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Introduction
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Materials and Methods
Study Population
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CCTA Image Acquisition
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CCTA Image Reconstruction and Evaluation
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ICA Image Acquisition and Evaluation
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Complexity of PCI
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Statistical Methods
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Results
Patient Characteristics
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TABLE 1
Baseline Characteristics
n = 154 Age (years) \* 66 ± 12 Male gender 107 (69) Hypertension 101 (65) Dyslipidemia 118 (76) Diabetes mellitus 38 (24) Current cigarette smoking 30 (19) Family history of premature CAD 62 (40) BMI (Kg/m 2 ) \* 27 ± 5 Previous MI 16 (10) Previous PCI 22 (14) Baseline creatinine (mg/dL) \* 1.07 ± 0.9 Baseline glomerular filtration rate \* (mL/min/1.73 m 2 ) 85 ± 27 Agatston coronary calcium score (n = 127) † 377 (148–940)
BMI, body mass index; CAD, coronary artery disease; MI, myocardial infarction; PCI, percutaneous coronary intervention.
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Agreement and Reproducibility of CCTA- and ICA-Derived SYNTAX Scores
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TABLE 2
Reproducibility Analyses—Inter-Observer Variability Between ICA Readers, CCTA Readers, as Well as Intra-observer Variability for Each of the CCTA Readers
SYNTAX Score Tertiles \* Number of Obstructive Lesions Bifurcation Lesions Total Occlusions Inter-observer variability ICA 0.81(0.71–0.92) 0.94(0.91–0.97) 0.64(0.55–0.74) 0.96(0.91–1.0) CCTA 0.85(0.76–0.94) 0.95(0.93–0.96) 0.71(0.59–0.84) 0.95(0.9–1.0) Intra-observer variability CCTA 1st reader 0.85(0.69–1.0) 0.94(0.90–0.99) 0.71(0.53–0.90) 1.0 CCTA 2nd reader 0.78(0.61–0.94) 0.98(0.96–1.0) 0.79(0.63–0.95) 0.86(0.67–1.0)
CCTA, coronary computed tomographic angiography; ICA, invasive coronary angiography.
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TABLE 3
SYNTAX CAD Variables: Comparison Between ICA and CCTA for 285 Lesions Considered Obstructive by Both
SYNTAX
Components \* Identified by ICA Correctly Diagnosed by CCTA (%) Agreement Between ICA and CCTA Total occlusion 36 34 (94) 0.94 (0.90–0.98) Bridging collaterals 19 9 (47) 0.63 (0.42–0.84) Compromised side branch 10 9 (90) 0.65 (0.44–0.86) Blunt stump 14 0 (0) 0 Segment visualized beyond occlusion 14 9 (64) 0.68 (0.47–0.89) Aorto-ostial lesion 7 5 (57) 0.66 (0.38–0.94) Bifurcation/trifurcation 73 53 (76) 0.56 (0.46–0.66) Length >20 mm 53 31 (58) 0.53 (0.38–0.69) Heavy calcification 28 24 (86) 0.76 (0.63–0.89) Intracoronary thrombus 2 0 (0) 0 Diffuse disease 19 13 (68) 0.63 (0.42–0.83)
CAD, coronary artery disease; CCTA, coronary computed tomographic angiography; ICA, invasive coronary angiography.
Agreement is presented as kappa values (95% confidence intervals).
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Comparison Between Patients Referred to PCI vs CABG or Medical Therapy
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TABLE 4
CCTA- and ICA-derived Per-patient and Segmental SYNTAX Scores According to Therapeutic Approach
Per Patient SYNTAX Score Medical Management ( n = 26 Patients) PCI ( n = 113) CABG ( n = 15) CCTA 6.8 ± 4.1 10.3 ± 6.3 23.5 ± 14.6 \* , † ICA 7.2 ± 5.4 10.1 ± 6.1 21.7 ± 12.1 \* , † Segmental SYNTAX score Medical management (n = 78 lesions) PCI (n = 154 lesions) CABG (n = 48 lesions) CCTA 4.9 ± 3.7 5.3 ± 3.5 6.4 ± 4.5 \* ICA 5.0 ± 3.8 5.5 ± 3.5 6.5 ± 4.4 \*
CCTA, coronary computed tomographic angiography; CABG, coronary artery bypass graft; ICA, invasive coronary angiography; PCI, percutaneous coronary intervention.
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Secondary Analysis of Patients Undergoing PCI
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Total Contrast Volume
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TABLE 5
Total Fluoroscopy Time and Contrast Volume According to Total and Segmental SYNTAX Score Tertiles Among PCI Subgroup (n = 113)
1st Tertile 2nd Tertile 3rd Tertile P Value Overall SYNTAX score ICA Mean ± SD Contrast volume (mL) 153.4 ± 62.7 193.0 ± 64.8 251.7 ± 139.4 <0.001 Total fluoroscopy time (min) 12.7 ± 9.2 16.4 ± 9.8 22.1 ± 14.6 <0.001 CCTA Contrast volume (ml) 152.7 ± 62.7 188.6 ± 63.7 251.8 ± 133.6 <0.001 Total fluoroscopy time (min) 12.6 ± 9.0 17.0 ± 10.4 21.5 ± 14.2 <0.001 Segmental SYNTAX scores ICA Mean ± SD Contrast volume (mL) 135.7 ± 43.2 184.2 ± 59.2 222.7 ± 127.1 <0.01 Total fluoroscopy time (min) 10.6 ± 4.8 17 ± 11.6 18.7 ± 12.5 0.02 CCTA Contrast volume (mL) 144.3 ± 49 194.3 ± 68.4 215.4 ± 125.5 0.01 Total fluoroscopy time (min) 11.5 ± 7.9 19.2 ± 11.6 17.5 ± 12 0.03
CCTA, coronary computed tomographic angiography; ICA, invasive coronary angiography; PCI, percutaneous coronary intervention.
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Total Fluoroscopy Time
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Procedure Failure or Complication
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Discussion
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Supplementary Data
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Appendix S1
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