Abstract 15090: Coronary Computed Tomography Provides Local SYNTAX Scores for Complex Culprit Lesions Correlating with Angiography
Introduction: Coronary computed tomography angiography (CCTA) is increasingly used to exclude significant coronary artery disease non-invasively. Experience about its potential for guiding percutaneous coronary interventions (PCI) is limited to chronic total occlusions. The angiographic SYNTAX Score has been developed to determine the complexity of coronary artery disease and to identify patients at risk for major adverse events following PCI. It comprises e.g. lesion anatomy, vessel tortuosity, lesion length, plaque calcification and others.
Hypothesis: The SYNTAX Score calculated from CCTA might provide information on lesion complexity prior to invasive diagnostics and allow for early risk stratification of PCI. Hence, the correlation between lesion-related SYNTAX Scores obtained by CCTA and coronary angiography was investigated.
Methods: From a series of 79 consecutive patients undergoing CCTA for any clinical or scientific purposes, 33 underwent PCI for 66 single de novo lesions within 6 months. Local SYNTAX Score of each lesion was calculated from CCTA and coronary angiography by independent investigators.
Results: There was a significant correlation between local SYNTAX Scores assessed by CCTA and those obtained by coronary angiography (Spearman's rank correlation coefficient = 0.631; p<0.001). Upon splitting the SYNTAX Scores obtained by CCTA into 3 intervals, the mean values ± standard deviation of the SYNTAX Scores assessed by coronary angiography are 2.8±1.2 for values of the local SYNTAX Scores by CCTA in the interval < 2, 6.1±2.9 in the interval 2-11, and 12.0±7.3 for all values > 11 (Bonferroni adjusted p-value: p<0.001). Attempted PCI failed in 6 (9%) out of 66 interventions, attributable to the higher complexity of coronary artery disease in this cohort selected for pre-procedural CCTA. SYNTAX Scores from CCTA and coronary angiography were comparably predictive for failed PCI with an area under the curve of 0.77 versus 0.73 in ROC analysis.
Conclusions: In conclusion, local SYNTAX Scores of CCTA and coronary angiography are correlated. This suggests that the CT-generated local SYNTAX Score may provide substantial advance information for lesion characterization and guidance of PCI.
- © 2011 by American Heart Association, Inc.