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Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
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Accuracy of computed tomography for selecting the revascularization method based on SYNTAX score II.

Si Eun Lee1, Kyunghwa Han1, Jin Hur1

  • 1Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.

European Radiology
|December 10, 2017
PubMed
Summary

Coronary CT angiography (CCTA) with SYNTAX score II accurately identifies candidates for coronary artery bypass grafting (CABG) surgery. This method improves upon previous assessments, offering a reliable alternative to invasive procedures for treatment selection.

Keywords:
Coronary artery bypass graftingCoronary computed tomography angiographyRevascularizationSYNTAX score ISYNTAX score II

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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.