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Vol 74, No 1 (2016)
Original articles
Published online: 2015-07-16
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Coronary computed tomography angiography for the assessment of SYNTAX score

Rafał Wolny, Jan Jastrzębski, Michał Szubielski, Jerzy Pręgowski, Paweł Danielski, Łukasz Kochanowski, Cezary Kępka, Maciej Karcz, Zbigniew Chmielak, Adam Witkowski
DOI: 10.5603/KP.a2015.0135
·
Kardiol Pol 2016;74(1):40-46.

open access

Vol 74, No 1 (2016)
Original articles
Published online: 2015-07-16

Abstract

Background: 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 ICA and 16.0 (14.3–19.4) 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.

Abstract

Background: 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 ICA and 16.0 (14.3–19.4) 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.

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Keywords

coronary computed tomography angiography, SYNTAX score, reproducibility, coronary artery disease

About this article
Title

Coronary computed tomography angiography for the assessment of SYNTAX score

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 74, No 1 (2016)

Pages

40-46

Published online

2015-07-16

DOI

10.5603/KP.a2015.0135

Bibliographic record

Kardiol Pol 2016;74(1):40-46.

Keywords

coronary computed tomography angiography
SYNTAX score
reproducibility
coronary artery disease

Authors

Rafał Wolny
Jan Jastrzębski
Michał Szubielski
Jerzy Pręgowski
Paweł Danielski
Łukasz Kochanowski
Cezary Kępka
Maciej Karcz
Zbigniew Chmielak
Adam Witkowski

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