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Randomized Controlled Trial
. 2022 Jan 18;34(2):176-184.
doi: 10.1093/icvts/ivab249.

Impact of coronary calcification assessed by coronary CT angiography on treatment decision in patients with three-vessel CAD: insights from SYNTAX III trial

Daniele Andreini  1   2 , Kuniaki Takahashi  3 , Saima Mushtaq  1 , Edoardo Conte  1 , Rodrigo Modolo  3   4 , Jeroen Sonck  5 , Johan De Mey  6 , Paolo Ravagnani  1 , Danny Schoors  7 , Francesco Maisano  7 , Philipp Kaufmann  7 , Wietze Lindeboom  8 , Marie-Angele Morel  8 , Torsten Doenst  9 , Ulf Teichgräber  9 , Gianluca Pontone  1 , Giulio Pompilio  1   2 , Antonio Bartorelli  1   10 , Yoshinobu Onuma  11 , Patrick W Serruys  12 ; Syntax III Revolution Investigators
Affiliations
Randomized Controlled Trial

Impact of coronary calcification assessed by coronary CT angiography on treatment decision in patients with three-vessel CAD: insights from SYNTAX III trial

Daniele Andreini et al. Interact Cardiovasc Thorac Surg. .

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.

Keywords: Coronary calcification; Coronary computed tomography angiography; Heart team.

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Figures

Figure 1:
Figure 1:
Anatomical SYNTAX score. Correlations (upper panels) and differences (bottom panels) between anatomical Syntax score derived from CCTA and ICA in patients with (left panels) and without (right panels) heavy coronary calcifications. CCTA: coronary computed tomography angiography; ICA: invasive coronary angiography.
Figure 2:
Figure 2:
Calcified coronary lesion with Syntax score discrepancy. A case of a heavily calcified lesion leading to discrepancy between CCTA-derived (A) and ICA-derived (B) SYNTAX scores. CCTA: coronary computed tomography angiography; ICA: invasive coronary angiography; LAD: left anterior descending; LCX: left circumflex.
Figure 3:
Figure 3:
Calcified coronary lesion without Syntax score discrepancy. A case of a heavily calcified lesion not affecting the calculation of CCTA-derived (A) and ICA-derived (B) SYNTAX scores. CCTA: coronary computed tomography angiography; ICA: invasive coronary angiography; LAD: left anterior descending; LCX: left circumflex.
None
See this image and copyright information in PMC

References

    1. Vavere A, Arbab-Zadeh A, Rochitte CE, Dewey M, Ninuma H, Gottlieb I et al. Coronary artery stenosis: accuracy of 64-detector row CT angiography in segments with mid, moderate, or severe calcification—a subanalysis of the CORE-64 trial. Radiology 2011;261:100–8. - PMC - PubMed
    1. Andreini D, Pontone G, Mushtaq S, Bertella E, Conte E, Segurini C et al. Diagnostic accuracy of rapid kilovolt peak-switching dual-energy CT coronary angiography in patients with a high calcium score. JACC Cardiovasc Imaging 2015;8:746–8. - PubMed
    1. Pontone G, Bertella E, Mushtaq S, Loguercio M, Cortinovis S, Baggiano A et al. Coronary artery disease: diagnostic accuracy of CT coronary angiography—a comparison of high and standard spatial resolution scanning. Radiology 2014;271:688–94. - PubMed
    1. Collet C, Onuma Y, Andreini D, Sonck J, Pompilio G, Mushtaq S et al. Coronary computed tomography angiography for heart team decision-making in multivessel coronary artery disease. Eur Heart J 2018;1:3689–98. - PMC - PubMed
    1. Cavalcante R, Onuma Y, Sotomi Y, Collet C, Thomsen B, Rogers C et al. Non-invasive Heart Team assessment of multivessel coronary disease with coronary computed tomography angiography based on SYNTAX score II treatment recommendations: design and rationale of the randomised SYNTAX III Revolution trial. EuroIntervention 2017;12:2001–8. - PubMed

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