Accuracy of computed tomography for selecting the revascularization method based on SYNTAX score II

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Medical Diagnostics

Background:

• Coronary CT angiography (CCTA) is a non-invasive imaging technique for evaluating coronary artery disease.
• The SYNTAX score is used to assess the complexity of coronary artery disease and guide revascularization decisions.
• SYNTAX score II incorporates clinical factors to refine treatment selection compared to SYNTAX score I.

Purpose of the Study:

• To evaluate the diagnostic performance of CCTA combined with SYNTAX score II for selecting revascularization methods.
• To compare CCTA-based SYNTAX score II with invasive coronary angiography (ICA)-based scores according to 2014 ESC/EACTS guidelines.

Main Methods:

• A cohort of 160 patients who underwent both CCTA and ICA within 30 days was analyzed.
• Diagnostic performance metrics (sensitivity, specificity, PPV, NPV, accuracy) were calculated for CCTA, CCTA + CT-SYNTAX I, and CCTA + CT-SYNTAX II.
• ICA and ICA-based SYNTAX scores served as the reference standards.

Main Results:

• CCTA + CT-SYNTAX I showed 70.6% sensitivity and 95.8% specificity for selecting CABG candidates.
• CCTA + CT-SYNTAX II demonstrated improved diagnostic performance with 83.3% sensitivity and 97.3% specificity.
• The accuracy for CCTA + CT-SYNTAX II was 96.3%, outperforming CCTA + CT-SYNTAX I (93.1%).

Conclusions:

• CCTA combined with CT-SYNTAX score II is an accurate diagnostic tool for selecting CABG surgery candidates.
• This non-invasive approach offers high specificity for guiding revascularization decisions.
• SYNTAX score II, by including clinical considerations, enhances the selection process for coronary artery bypass grafting.