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Abstract
OBJECTIVES
The aim of this study was to determine Syntax scores based on coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) and to assess whether heavy coronary calcification significantly limits the CCTA evaluation and the impact of severe calcification on heart team’s treatment decision and procedural planning in patients with three-vessel coronary artery disease (CAD) with or without left main disease.
METHODS
SYNTAX III was a multicentre, international study that included patients with three-vessel CAD with or without left main disease. The heart teams were randomized to either assess coronary arteries with coronary CCTA or ICA. We stratified the patients based on the presence of at least 1 lesion with heavy calcification defined as arc of calcium >180° within the lesion using CCTA. Agreement on the anatomical SYNTAX score and treatment decision was compared between patients with and without heavy calcifications.
RESULTS
Overall, 222 patients with available CCTA and ICA were included in this trial subanalysis (104 with heavy calcification, 118 without heavy calcification). The mean difference in the anatomical SYNTAX score (CCTA derived—ICA derived) was lower in patients without heavy calcifications [mean (−1.96 SD; +1.96 SD) = 1.5 (−19.3; 22.4) vs 5.9 (−17.5; +29.3), P = 0.004]. The agreement on treatment decision did not differ between patients with (Cohen’s kappa 0.79) or without coronary calcifications (Cohen’s kappa 0.84). The agreement on the treatment planning did not differ between patients with (concordance 80.3%) or without coronary calcifications (concordance 82.8%).
CONCLUSIONS
An overall good correlation between CCTA- and ICA-derived Syntax score was found. The presence of heavy coronary calcification moderately influenced the agreement between CCTA and ICA on the anatomical SYNTAX score. However, agreement on the treatment decision and planning was high and irrespective of the presence of calcified lesions.
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Details
1 Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS , Milan, Italy
2 Department of Cardiology, Amsterdam University Medical Center , Amsterdam, Netherlands
3 Cardiovascular Center Aalst, OLV Hospital , Aalst, Belgium
4 Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussel, Belgium
5 University of Zurich , Zurich, Switzerland
6 Cardialysis BV , Rotterdam, Netherlands
7 Jena University Hospital, Friedrich-Schiller-University of Jena , Jena, Germany
8 Thoraxcenter, Erasmus MC , Rotterdam, Netherlands
9 Department of Cardiology, Royal Brompton and Harefield Hospitals, Imperial College London , London, UK