Aryeh Shalev1, Ryo Nakazato1, Reza Arsanjani1, Rine Nakanishi1, Hyung-Bok Park1, Yuka Otaki1, Victor Y Cheng2, Heidi Gransar1, Troy M LaBounty3, Sean W Hayes1, Daniel S Berman4, James K Min5. 1. Departments of Imaging (Division of Nuclear Medicine) and Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute, Los Angeles, California. 2. Oklahoma Heart Institute, Tulsa, Oklahoma. 3. Departments of Medicine and Radiology, University of Michigan, Ann Harbor, Michigan. 4. Departments of Imaging (Division of Nuclear Medicine) and Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute, Los Angeles, California; Department of Medicine, David Geffen UCLA School of Medicine, University of California Los Angeles, Los Angeles, California. 5. Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital, 413 E 69th Street, BRB 108, New York, NY 10021. Electronic address: jkm2001@med.cornell.edu.
Abstract
RATIONALE AND OBJECTIVES: SYNTAX score is a useful metric determined at the time of invasive coronary angiography (ICA) to assess the complexity of coronary artery disease, and improves prediction of complications at the time of percutaneous complex intervention (PCI). We aimed to determine whether SYNTAX score can be reliably determined from coronary computed tomography angiography (CCTA) and whether a CCTA-derived SYNTAX score can predict complex PCI. MATERIALS AND METHODS: SYNTAX scores were calculated on per-patient, per-vessel, and per-segment basis in 154 consecutive patients who underwent CCTA and ICA. PCI complexity in 113 patients who underwent intervention was defined by total fluoroscopy time and contrast volume. RESULTS: Compared to ICA, CCTA detected 285 of 302 (94%) obstructive lesions in 230 vessels, for which PCI was performed for 154 lesions in 131 vessels. Overall, on a per-patient basis, ICA-derived SYNTAX score was lower in comparison to CCTA-derived score (10.2 ± 8.0 vs 10.9 ± 8.3, P = 0.001). As compared to lesions in the lowest CCTA-derived segmental SYNTAX tertile, lesions in the highest tertile required longer fluoroscopy time (17.5 ± 12 min vs 11.5 ± 7.9 min, P = 0.01) and greater contrast volume (215.4 ± 125.5 mL vs 144.3 ± 49 mL, P = 0.02). CONCLUSION: SYNTAX scores derived from CCTA are concordant with those derived from ICA and correspond with complex PCI.
RATIONALE AND OBJECTIVES: SYNTAX score is a useful metric determined at the time of invasive coronary angiography (ICA) to assess the complexity of coronary artery disease, and improves prediction of complications at the time of percutaneous complex intervention (PCI). We aimed to determine whether SYNTAX score can be reliably determined from coronary computed tomography angiography (CCTA) and whether a CCTA-derived SYNTAX score can predict complex PCI. MATERIALS AND METHODS: SYNTAX scores were calculated on per-patient, per-vessel, and per-segment basis in 154 consecutive patients who underwent CCTA and ICA. PCI complexity in 113 patients who underwent intervention was defined by total fluoroscopy time and contrast volume. RESULTS: Compared to ICA, CCTA detected 285 of 302 (94%) obstructive lesions in 230 vessels, for which PCI was performed for 154 lesions in 131 vessels. Overall, on a per-patient basis, ICA-derived SYNTAX score was lower in comparison to CCTA-derived score (10.2 ± 8.0 vs 10.9 ± 8.3, P = 0.001). As compared to lesions in the lowest CCTA-derived segmental SYNTAX tertile, lesions in the highest tertile required longer fluoroscopy time (17.5 ± 12 min vs 11.5 ± 7.9 min, P = 0.01) and greater contrast volume (215.4 ± 125.5 mL vs 144.3 ± 49 mL, P = 0.02). CONCLUSION: SYNTAX scores derived from CCTA are concordant with those derived from ICA and correspond with complex PCI.
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