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Accuracy of CT for Selecting Candidates for Coronary Artery Bypass Graft Surgery: Combination with the SYNTAX Score

Young Joo Suh1, Yoo Jin Hong1, Hye-Jeong Lee1

  • 1From the Department of Radiology, Research Institute of Radiological Science (Y.J.S., Y.J.H., H.J.L., J.H., Y.J.K., S.R.H., T.H.K., B.W.C.), Department of Cardiovascular Surgery (K.J.Y.), and Division of Cardiology, Department of Internal Medicine (H.J.C.), Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea; and Department of Radiology, Chung-Ang University Medical Center, Seoul, Korea (J.S.S.).

Radiology
|March 12, 2015
PubMed

Insights

Coronary CT angiography accurately identifies candidates for coronary artery bypass graft (CABG) surgery. Adding the CT-based SYNTAX score enhances specificity for selecting appropriate CABG surgery candidates.

Area of Science:

  • Cardiovascular Imaging
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Coronary artery disease (CAD) management requires accurate patient selection for revascularization.
  • Coronary artery bypass graft (CABG) surgery is a key treatment for severe CAD.
  • Non-invasive imaging modalities are increasingly explored to optimize surgical candidate selection.

Purpose of the Study:

  • To evaluate the diagnostic performance of coronary computed tomographic (CT) angiography for selecting CABG surgery candidates.
  • To assess the added value of SYNTAX (Synergy between PCI with TAXUS and Cardiac Surgery) scoring in conjunction with coronary CT angiography for this selection process.
  • To compare diagnostic accuracy against established guidelines (2011 ACCF/AHA).

Main Methods:

  • Retrospective analysis of 399 patients who underwent both coronary CT angiography and invasive coronary angiography.
  • Application of 2011 ACCF/AHA guidelines for CABG eligibility criteria.
  • Calculation of SYNTAX scores based on both CT angiography and invasive coronary angiography findings.
  • Statistical comparison of diagnostic performance metrics (sensitivity, specificity, PPV, NPV).

Main Results:

  • Coronary CT angiography demonstrated high overall diagnostic performance (sensitivity 96.5%, specificity 96.5%, PPV 88.3%, NPV 99.0%) for selecting CABG candidates.
  • Combining coronary CT angiography with a CT-based SYNTAX score significantly improved specificity (98.3%) and PPV (86.0%) compared to CT angiography alone.
  • These improvements were noted when compared against invasive coronary angiography and its derived SYNTAX score as the reference standard.

Conclusions:

  • Coronary CT angiography offers diagnostic accuracy comparable to invasive coronary angiography for CABG candidate selection.
  • Integrating a CT-based SYNTAX score with coronary CT angiography provides a highly specific method for identifying suitable CABG surgery candidates.
  • This combined approach can refine patient selection for CABG surgery.
Abstract

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