Impact of coronary calcification assessed by coronary CT angiography on treatment decision in patients with three-vessel CAD: insights from SYNTAX III trial

Abstract

OBJECTIVES The aim of this study was to determine Syntax scores based on coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) and to assess whether heavy coronary calcification significantly limits the CCTA evaluation and the impact of severe calcification on heart team’s treatment decision and procedural planning in patients with three-vessel coronary artery disease (CAD) with or without left main disease. METHODS SYNTAX III was a multicentre, international study that included patients with three-vessel CAD with or without left main disease. The heart teams were randomized to either assess coronary arteries with coronary CCTA or ICA. We stratified the patients based on the presence of at least 1 lesion with heavy calcification defined as arc of calcium >180° within the lesion using CCTA. Agreement on the anatomical SYNTAX score and treatment decision was compared between patients with and without heavy calcifications. RESULTS Overall, 222 patients with available CCTA and ICA were included in this trial subanalysis (104 with heavy calcification, 118 without heavy calcification). The mean difference in the anatomical SYNTAX score (CCTA derived—ICA derived) was lower in patients without heavy calcifications [mean (−1.96 SD; +1.96 SD) = 1.5 (−19.3; 22.4) vs 5.9 (−17.5; +29.3), P = 0.004]. The agreement on treatment decision did not differ between patients with (Cohen’s kappa 0.79) or without coronary calcifications (Cohen’s kappa 0.84). The agreement on the treatment planning did not differ between patients with (concordance 80.3%) or without coronary calcifications (concordance 82.8%). CONCLUSIONS An overall good correlation between CCTA- and ICA-derived Syntax score was found. The presence of heavy coronary calcification moderately influenced the agreement between CCTA and ICA on the anatomical SYNTAX score. However, agreement on the treatment decision and planning was high and irrespective of the presence of calcified lesions.

Treatment recommendation based on SYNTAX score 2020 derived from coronary computed tomography angiography and invasive coronary angiography

“…CCTA was performed exclusively at all four academic sites using the Revolution CT scanner (GE Healthcare, Milwaukee, WI, USA) which has a nominal spatial resolution of 230 microns along the X–Y planes, a rotational speed of 0.28 s, and a Z-plane coverage of 16 cm enabling imaging of the whole heart in one heartbeat [ 9 , 10 ]. In select cases, a proprietary post-processing algorithm (SnapShot Freeze, GE Healthcare) was used for the additional correction of any residual motion artifacts.…”

Treatment Recommendation Based on SYNTAX score 2020 Derived from Coronary Computed Tomography Angiography and Invasive Coronary Angiography

“…Image acquisition and analysis of CCTA CCTA was performed exclusively at all four academic sites using the Revolution CT scanner (GE Healthcare, Milwaukee, WI, USA) which has a nominal spatial resolution of 230 microns along the X-Y planes, a rotational speed of 0.28 sec, and a Z-plane coverage of 16 cm enabling imaging of the whole heart in one heartbeat [9,10] . In select cases, a proprietary post-processing algorithm (SnapShot Freeze, GE Healthcare) was used for the additional correction of any residual motion artifacts.…”