SYNTAX Score in Patients with High Computed Tomography Coronary Calcium Score

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Coronary artery disease (CAD) is a leading cause of mortality.
• Multidetector computed tomography (CT) is increasingly used for non-invasive assessment of coronary calcification.
• High coronary calcium burden can sometimes hinder the interpretation of conventional coronary angiography (CA).

Purpose of the Study:

• To evaluate the correlation between high coronary calcium scores on CT and findings on conventional coronary angiography.
• To assess the diagnostic utility of CT coronary calcium scoring in patients with intermediate to high cardiovascular risk.

Main Methods:

• Fifty patients with high coronary calcium scores on CT underwent conventional coronary angiography.
• Investigators calculated Framingham Risk Score (FRS), CT coronary calcium score (CCS), and SYNTAX score (SS) while blinded to other scores.
• 250 coronary arteries were analyzed for lesions using both CT and CA.

Main Results:

• A strong agreement was observed between CCS and SS (r=0.68, P<0.01), particularly for very high CCS (>1000).
• Individual vessel calcium scores correlated strongly with the presence of any lesion (r=0.52, P<0.01) but weakly with significant stenosis (r=0.29, P=0.05).
• 32% of patients with CCS between 350-1000 had no significant CAD on conventional CA.

Conclusions:

• High CT CCS correlates well with the overall burden of CAD, especially at very high scores.
• CT coronary calcium scoring is valuable for detecting any coronary lesions but shows weaker correlation for significant stenosis.
• A significant proportion of patients with moderate-to-high CCS may not have hemodynamically significant CAD.