Accuracy of computed tomography for selecting the revascularization method based on SYNTAX score II
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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.
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.
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.
CCTA combined with CT-SYNTAX score II is an accurate method for selecting CABG surgery candidates compared with ICA-SYNTAX score II.
• 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.
KeywordsCoronary computed tomography angiography SYNTAX score I SYNTAX score II Revascularization Coronary artery bypass grafting
Area under curve
Coronary artery bypass grafting
Coronary artery disease
Coronary computed tomography angiography
Chronic obstructive pulmonary disease
European Society of Cardiology/European Association for Cardio-Thoracic Surgery
Generalized estimating equations
Glomerular filtration rate
Invasive coronary angiography
Negative predictive value
Percutaneous coronary intervention
Positive predictive value
Peripheral vascular disease
This study was supported by a Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (NRF-2013R1A1A2010729).
Compliance with ethical standards
The scientific guarantor of this publication is Byoung Wook Choi.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
One of the authors has significant statistical expertise.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• diagnostic or prognostic study
• performed at one institution
- 3.Budoff MJ, Dowe D, Jollis JG et al (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol 52:1724–1732CrossRefPubMedGoogle Scholar
- 13.Mohr FW, Morice MC, Kappetein AP et al (2013) Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 381:629–638CrossRefPubMedGoogle Scholar
- 15.Windecker S, Kolh P, Alfonso F et al (2014) 2014 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J :ehu278Google Scholar
- 20.Farooq V, van Klaveren D, Steyerberg EW et al (2013) Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and percutaneous coronary intervention for individual patients: development and validation of SYNTAX score II. Lancet 381:639–650CrossRefPubMedGoogle Scholar
- 22.Campos CM, van Klaveren D, Farooq V et al (2015) Long-term forecasting and comparison of mortality in the Evaluation of the Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial: prospective validation of the SYNTAX Score II. Eur Heart J 36:1231–1241CrossRefPubMedGoogle Scholar