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Schaab JA, Candreva A, Rossi A, Markendorf S, Sager D, Messerli M, Pazhenkottil AP, Benz DC, Kaufmann PA, Buechel RR, Stähli BE, Giannopoulos AA. A simple coronary CT angiography-based jeopardy score for the identification of extensive coronary artery disease: Validation against invasive coronary angiography. Diagn Interv Imaging 2024; 105:151-158. [PMID: 38007373 DOI: 10.1016/j.diii.2023.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 11/27/2023]
Abstract
PURPOSE The invasive British Cardiovascular Intervention Society Jeopardy Score (iBCIS-JS) is a simple angiographic scoring system, enabling quantification of the extent of jeopardized myocardium related to clinically significant coronary artery disease (CAD). The purpose of this study was to develop and validate the coronary CT angiography-based BCIS-JS (CT-BCIS-JS) against the iBCIS-JS in patients with suspected or stable CAD. MATERIALS AND METHODS Patients who underwent coronary CT angiography followed by invasive coronary angiography, within 90 days were retrospectively included. CT-BCIS-JS and iBCIS-JS were calculated, with a score ≥ 6 indicating extensive CAD. Correlation between the CT-BCIS-JS and iBCIS-JS was searched for using Spearman's coefficient, and agreement with weighted Kappa (κ) analyses. RESULTS A total of 122 patients were included. There were 102 men and 20 women with a median age of 62 years (Q1, Q3: 54, 68; age range: 19-83 years). No differences in median CT-BCIS-JS (4; Q1, Q3: 0, 8) and median iBCIS-JS (4; Q1, Q3: 0, 8) were found (P = 0.18). Extensive CAD was identified in 53 (43.4%) and 52 (42.6%) patients using CT-BCIS-JS and iBCIS-JS, respectively (P = 0.88). CT-based and iBCIS-JS showed excellent correlation (r = 0.98; P < 0.001) and almost perfect agreement (κ = 0.93; 95% confidence interval: 0.90-0.97). Agreement for identification of an iBCIS-JS ≥ 6 was almost perfect (κ = 0.94; 95 % confidence interval: 0.87-0.99). CONCLUSION The CT-BCIS-JS represents a feasible, and accurate method for quantification of CAD, with capabilities not different from those of iBCIS-JS. It enables simple, non-invasive identification of patients with anatomically extensive CAD.
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Affiliation(s)
- Jan A Schaab
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Alessandro Candreva
- Department of Cardiology, University Heart Center, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Alexia Rossi
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Susanne Markendorf
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Dominik Sager
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, CH-8091 Zurich, Switzerland; Department of Cardiology, University Heart Center, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, CH-8091 Zurich, Switzerland; Department of Cardiology, University Heart Center, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Andreas A Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, CH-8091 Zurich, Switzerland.
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Khedr AAEG, Dawoud MF, Salama ASA, Allah TMA, El-Deeb BS. Multi-slice coronary computed tomography angiography in assessment of coronary artery disease on the basis of syntax score. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2023; 54:18. [DOI: 10.1186/s43055-023-00958-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/31/2022] [Indexed: 09/01/2023] Open
Abstract
Abstract
Background
The SYNTAX score (SS) was created to aid the Heart Team in assessing the severity and extent of coronary artery disease (CAD) in patients with multi-vessel disease, hence helping in the decision between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). SS is an important tool that assesses the angiographic complexity of the CAD based on Invasive coronary angiography (ICA). The study aims to evaluate the role of coronary Multi-Slice Computed Tomography (MSCT) angiography in the assessment of CAD on the basis of SS.
Results
Our study involved 60 patients with a male to female ratio 78.4% to 21.6%. The mean age of the patients was 57 years. Then, we applicate SYNTAX score II (SS-II) by incorporating a combination of SS-I and clinical variables. MSCT findings were compared with the data collected by cardiac catheterization. SYNTAX scores produced from coronary CT-angiography (CCTA) and those derived from ICA are concordant (P = 0.001). Direct correlation and significant relationship between SS-II for PCI and the mortality rate with the CT-derived SS-I. There was an inverse relationship between the CT-derived SS-I and SS-II for CABG. There was an inverse relationship between the CT-derived-SS with CABG mortality rate.
Conclusions
MSCT is a noninvasive imaging modality that has a significant value and high diagnostic accuracy compared to ICA in the evaluation of the complexity of CAD using SS and can be applied in clinical practice to determine the most convenient treatment procedure and predict long-term prognosis.
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Fractional Flow Reserve Derived From Computed Tomographic Angiography in Patients With Multivessel CAD. J Am Coll Cardiol 2018; 71:2756-2769. [PMID: 29802016 DOI: 10.1016/j.jacc.2018.02.053] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/18/2018] [Accepted: 02/19/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND The functional SYNTAX score (FSS) has been shown to improve the discrimination for major adverse cardiac events compared with the anatomic SYNTAX score (SS) while reducing interobserver variability. However, evidence supporting the noninvasive FSS in patients with multivessel coronary artery disease (CAD) is scarce. OBJECTIVES The purpose of this study was to assess the feasibility of and validate the noninvasive FSS derived from coronary computed tomography angiography (CTA) with fractional flow reserve (FFRCT) in patients with 3-vessel CAD. METHODS The CTA-SS was calculated in patients with 3-vessel CAD included in the SYNTAX II (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery II) study. The noninvasive FSS was determined by including only ischemia-producing lesions (FFRCT ≤0.80). SS derived from different imaging modalities were compared using the Bland-Altman and Passing-Bablok method, and the agreement on the SS tertiles was investigated with Cohen's Kappa. The risk reclassification was compared between the noninvasive and invasive physiological assessment, and the diagnostic accuracy of FFRCT was assessed by the area under the receiver-operating characteristic curve using instantaneous wave-free ratio as a reference. RESULTS The CTA-SS was feasible in 86% of patients (66 of 77), whereas the noninvasive FSS was feasible in 80% (53 of 66). The anatomic SS was overestimated by CTA compared with conventional angiography (27.6 ± 6.4 vs. 25.3 ± 6.9; p < 0.0001) whereas the calculation of the FSS yielded similar results between the noninvasive and invasive imaging modalities (21.6 ± 7.8 vs. 21.2 ± 8.8; p = 0.589). The noninvasive FSS reclassified 30% of patients from the high- and intermediate-SS tertiles to the low-risk tertile, whereas invasive FSS reclassified 23% of patients from the high- and intermediate-SS tertiles to the low-risk tertile. The agreement on the classic SS tertiles based on Kappa statistics was slight for the anatomic SS (Kappa = 0.19) and fair for the FSS (Kappa = 0.32). The diagnostic accuracy of FFRCT to detect functional significant stenosis based on an instantaneous wave-free ratio ≤0.89 revealed an area under the receiver-operating characteristics curve of 0.85 (95% CI: 0.79 to 0.90) with a sensitivity of 95% (95% CI: 89% to 98%), specificity of 61% (95% CI: 48% to 73%), positive predictive value of 81% (95% CI: 76% to 86%), and negative predictive value of 87% (95% CI: 74% to 94%). CONCLUSIONS Calculation of the noninvasive FSS is feasible and yielded similar results to those obtained with invasive pressure-wire assessment. The agreement on the SYNTAX score tertile classification improved with the inclusion of the functional component from slight to fair agreement. FFRCT has good accuracy in detecting functionally significant lesions in patients with 3-vessel CAD. (A Trial to Evaluate a New Strategy in the Functional Assessment of 3-Vessel Disease Using SYNTAX II Score in Patients Treated With PCI; NCT02015832).
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Accuracy of computed tomography for selecting the revascularization method based on SYNTAX score II. Eur Radiol 2017; 28:2151-2158. [PMID: 29222675 DOI: 10.1007/s00330-017-5184-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/24/2017] [Accepted: 11/07/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The application of SYNTAX score II based on coronary CT angiography (CCTA) for selecting further treatment options has not been studied. This study aimed to investigate the diagnostic performance of CCTA combined with SYNTAX score II for selecting the revascularization method compared with invasive coronary angiography (ICA) based on 2014 European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) guidelines. METHODS From January-May 2011, 160 patients who underwent both CCTA and ICA within 30 interval days were included. The diagnostic performance of CCTA, CCTA plus CT-SYNTAX score I and CT-SYNTAX score II was analysed using ICA counterparts as references. RESULTS Overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CCTA plus CT-SYNTAX I for selecting coronary artery bypass grafting (CABG) candidates using ICA plus ICA-SYNTAX I as reference, were 70.6 %, 95.8 %, 66.7 %, 96.5 % and 93.1 %, respectively. The diagnostic performance of CCTA plus CT-SYNTAX II showed improvement with values of 83.3 %, 97.3 %, 71.4 %, 98.6 % and 96.3 %, respectively, using ICA plus ICA-SYNTAX II as reference. CONCLUSIONS CCTA combined with CT-SYNTAX score II is an accurate method for selecting CABG surgery candidates compared with ICA-SYNTAX score II. KEY POINTS • SYNTAX plus CCTA can be highly specific for selecting the revascularization method. • SYNTAX II was complemented by including clinical considerations to SYNTAX I. • CCTA plus CT-SYNTAX II is an accurate method for selecting CABG candidates.
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Suh YJ, Han K, Chang S, Kim JY, Im DJ, Hong YJ, Lee HJ, Hur J, Kim YJ, Choi BW. SYNTAX score based on coronary computed tomography angiography may have a prognostic value in patients with complex coronary artery disease: An observational study from a retrospective cohort. Medicine (Baltimore) 2017; 96:e7999. [PMID: 28906380 PMCID: PMC5604649 DOI: 10.1097/md.0000000000007999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) score is an invasive coronary angiography (ICA)-based score for quantifying the complexity of coronary artery disease (CAD). Although the SYNTAX score was originally developed based on ICA, recent publications have reported that coronary computed tomography angiography (CCTA) is a feasible modality for the estimation of the SYNTAX score.The aim of our study was to investigate the prognostic value of the SYNTAX score, based on CCTA for the prediction of major adverse cardiac and cerebrovascular events (MACCEs) in patients with complex CAD.The current study was approved by the institutional review board of our institution, and informed consent was waived for this retrospective cohort study. We included 251 patients (173 men, mean age 66.0 ± 9.29 years) who had complex CAD [3-vessel disease or left main (LM) disease] on CCTA. SYNTAX score was obtained on the basis of CCTA. Follow-up clinical outcome data regarding composite MACCEs were also obtained. Cox proportional hazards models were developed to predict the risk of MACCEs based on clinical variables, treatment, and computed tomography (CT)-SYNTAX scores.During the median follow-up period of 1517 days, there were 48 MACCEs. Univariate Cox hazards models demonstrated that MACCEs were associated with advanced age, low body mass index (BMI), and dyslipidemia (P < .2). In patients with LM disease, MACCEs were associated with a higher SYNTAX score. In patients with CT-SYNTAX score ≥23, patients who underwent coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention had significantly lower hazard ratios than patients who were treated with medication alone. In multivariate Cox hazards model, advanced age, low BMI, and higher SYNTAX score showed an increased hazard ratio for MACCE, while treatment with CABG showed a lower hazard ratio (P < .2).On the basis of our results, CT-SYNTAX score can be a useful method for noninvasively predicting MACCEs in patients with complex CAD, especially in patients with LM disease.
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Affiliation(s)
- Young Joo Suh
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital
- Biostatistics Collaboration Unit, Medical Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Suyon Chang
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital
| | - Jin Young Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital
| | - Dong Jin Im
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital
| | - Yoo Jin Hong
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital
| | - Hye-Jeong Lee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital
| | - Jin Hur
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital
| | - Young Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital
| | - Byoung Wook Choi
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital
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Pozo E, Agudo-Quilez P, Rojas-González A, Alvarado T, Olivera MJ, Jiménez-Borreguero LJ, Alfonso F. Noninvasive diagnosis of vulnerable coronary plaque. World J Cardiol 2016; 8:520-533. [PMID: 27721935 PMCID: PMC5039354 DOI: 10.4330/wjc.v8.i9.520] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/01/2016] [Accepted: 07/22/2016] [Indexed: 02/06/2023] Open
Abstract
Myocardial infarction and sudden cardiac death are frequently the first manifestation of coronary artery disease. For this reason, screening of asymptomatic coronary atherosclerosis has become an attractive field of research in cardiovascular medicine. Necropsy studies have described histopathological changes associated with the development of acute coronary events. In this regard, thin-cap fibroatheroma has been identified as the main vulnerable coronary plaque feature. Hence, many imaging techniques, such as coronary computed tomography, cardiac magnetic resonance or positron emission tomography, have tried to detect noninvasively these histomorphological characteristics with different approaches. In this article, we review the role of these diagnostic tools in the detection of vulnerable coronary plaque with particular interest in their advantages and limitations as well as the clinical implications of the derived findings.
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Bettinger N, Palmerini T, Caixeta A, Dressler O, Litherland C, Francese DP, Giustino G, Mehran R, Leon MB, Stone GW, Généreux P. Risk stratification of patients undergoing medical therapy after coronary angiography. Eur Heart J 2015; 37:3103-3110. [DOI: 10.1093/eurheartj/ehv674] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 11/19/2015] [Indexed: 12/17/2022] Open
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Incremental diagnostic accuracy of computed tomography myocardial perfusion imaging over coronary angiography stratified by pre-test probability of coronary artery disease and severity of coronary artery calcification: The CORE320 study. Int J Cardiol 2015; 201:570-7. [DOI: 10.1016/j.ijcard.2015.05.110] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 04/13/2015] [Accepted: 05/14/2015] [Indexed: 11/20/2022]
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Bypass Grafting Versus Percutaneous Intervention-Which Is Better in Multivessel Coronary Disease: Lessons From SYNTAX and Beyond. Prog Cardiovasc Dis 2015; 58:316-34. [PMID: 26529569 DOI: 10.1016/j.pcad.2015.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The landmark Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) Trial has aided in reducing the area of uncertainty in decision-making between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery in patients with complex coronary artery disease. As part of the SYNTAX Trial, quantification of the coronary artery disease burden was prospectively undertaken by the Heart Team - consisting of at least an interventional cardiologist and cardiac surgeon - utilising the anatomical SYNTAX Score (www.syntaxscore.com) as a clinical tool in order to agree that equivalent anatomical revascularisation could be achieved. The anatomical SYNTAX Score is now advocated in both European and US revascularisation guidelines to guide decision-making between CABG and PCI as part of the SYNTAX pioneered Heart Team approach. In addition, the SYNTAX Trial has lead to the development and validation of the SYNTAX Score II, in which the anatomical SYNTAX Score was augmented with clinical variables, to allow for more objective and tailored decision making for the individual patient. Prospective validation of the SYNTAX Score II tool is currently ongoing in the SYNTAX II (ClinicalTrials.gov Identifier: NCT02015832) and EXCEL (ClinicalTrials.gov identifier: NCT01205776) trials. The present paper presents lessons learned from SYNTAX, including the development and/or validation of several SYNTAX based clinical tools, and the potential implications for current and future clinical practice.
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Suh YJ, Hong YJ, Lee HJ, Hur J, Kim YJ, Lee HS, Hong SR, Im DJ, Kim YJ, Park CH, Kim TH, Yoo KJ, Choi BW. Prognostic value of SYNTAX score based on coronary computed tomography angiography. Int J Cardiol 2015; 199:460-6. [PMID: 26296238 DOI: 10.1016/j.ijcard.2015.07.067] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 07/09/2015] [Accepted: 07/27/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The long-term prognostic value of the computed tomography (CT)-based SYNTAX score has not yet been investigated. The aim of our study was to investigate the prognostic value of the CT-SYNTAX score in predicting major adverse cardiac events (MACEs) in populations who underwent both coronary computed tomography (CCTA) and invasive coronary angiography (ICA), compared with prognostic values of coronary artery disease (CAD) findings on CCTA and the ICA-based SYNTAX score. METHODS We retrospectively included 339 patients (213 men, mean age of 63.8±9.45years) with suspected CAD who underwent CCTA and ICA. SYNTAX score was obtained based on both CCTA and ICA. Follow-up clinical outcome data regarding composite MACEs were obtained. Cox proportional hazard models were developed to predict MACEs based on clinical variables, number of CAD vessels, and SYNTAX scores based on CCTA and ICA. The time-dependent receiver operating characteristic curve method was used, and the integrated area under the curve (iAUC) was calculated to compare the predictive prognosis of the models. RESULTS During the median follow-up of 1374days, there were 30 MACEs. In multivariate Cox regression adjusted for clinical variables, SYNTAX score group 4 (≥33) on CCTA and SYNTAX score groups 3 (23-32) and 4 (≥33) on ICA showed increased hazard ratios for MACEs compared to SYNTAX score group 1 (0). CT-SYNTAX score demonstrated no significant difference in iAUC compared with ICA-SYNTAX score and the number of vessels of CAD on CCTA. CONCLUSIONS CT-SYNTAX score can be a useful method for non-invasively predicting MACEs, especially in patients with complex CAD.
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Affiliation(s)
- Young Joo Suh
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea
| | - Yoo Jin Hong
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea
| | - Hye-Jeong Lee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea
| | - Jin Hur
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea
| | - Young Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Medical Research Center, South Korea
| | - Sae Rom Hong
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea
| | - Dong Jin Im
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea
| | - Yun Jung Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea
| | - Chul Hwan Park
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea
| | - Tae Hoon Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea
| | - Kyung-Jong Yoo
- Department of Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, South Korea
| | - Byoung Wook Choi
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, South Korea.
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