Prognostic implication of CT-FFR based functional SYNTAX score in patients withde novothree-vessel disease

Abstract

Aims This study was aimed at investigating whether a machine learning (ML)-based coronary computed tomographic angiography (CCTA) derived fractional flow reserve (CT-FFR) SYNTAX score (SS), ‘Functional SYNTAX score’ (FSSCTA), would predict clinical outcome in patients with three-vessel coronary artery disease (CAD). Methods and results The SS based on CCTA (SSCTA) and ICA (SSICA) were retrospectively collected in 227 consecutive patients with three-vessel CAD. FSSCTA was calculated by combining the anatomical data with functional data derived from a ML-based CT-FFR assessment. The ability of each score system to predict major adverse cardiac events (MACE) was compared. The difference between revascularization strategies directed by the anatomical SS and FSSCTA was also assessed. Two hundred and twenty-seven patients were divided into two groups according to the SSCTA cut-off value of 22. After determining FSSCTA for each patient, 22.9% of patients (52/227) were reclassified to a low-risk group (FSSCTA ≤ 22). In the low- vs. intermediate-to-high (>22) FSSCTA group, MACE occurred in 3.2% (4/125) vs. 34.3% (35/102), respectively (P < 0.001). The independent predictors of MACE were FSSCTA (OR = 1.21, P = 0.001) and diabetes (OR = 2.35, P = 0.048). FSSCTA demonstrated a better predictive accuracy for MACE compared with SSCTA (AUC: 0.81 vs. 0.75, P = 0.01) and SSICA (0.81 vs. 0.75, P < 0.001). After FSSCTA was revealed, 52 patients initially referred for CABG based on SSCTA would have been changed to PCI. Conclusion Recalculating SS by incorporating lesion-specific ischaemia as determined by ML-based CT-FFR is a better predictor of MACE in patients with three-vessel CAD. Additionally, the use of FSSCTA may alter selected revascularization strategies in these patients.

Synergistic prognostic value of coronary distensibility index and fractional flow reserve based cCTA for major adverse cardiac events in patients with Coronary artery disease

“…Multiple studies confirmed CT-FFR is a better predictor of MACEs in patients with CAD, especially for patients with intermediate-range or severe-range coronary stenosis (≥ 50%). Moreover, patients with CT-FFR ≤ 0.80 had a higher risk of MACEs than patients with CT-FFR > 0.80 [ 5 , 11 , 24 , 25 ], which was consistent with our study. We suspected that CT-FFR can provide high sensitivity and specificity to identify myocardial ischemia, CT-FFR ≤ 0.80 can indicate functional ischemia, while myocardial ischemia was associated with a trend towards an increase in MACEs risk.…”

<b>Application of SYNTAX and its Derivative Scores in the Selection of Revascularization Strategies for Complex Coronary Heart Disease</b>

“…In comparison to CCTA-SS, FFRct better predicts MACE, improves diagnostic accuracy, and the calculated value of FFRct is similar to the functional SYNTAX score [58,59] . Another study confirmed that non-invasive FFRct was significantly associated with invasive FFR at the same time (FFRct AUC: 0.90, 95%CI: 0.87-0.94) [60] , and it can be used in the risk stratification assessment of cardiac surgery.…”

Perioperative Fluoroquinolone Treatment Deteriorates Prognosis Following Coronary Artery Bypass Grafting

“…Both preoperative conditions and perioperative therapies are determining factors of the clinical outcomes for CABG patients [ 15 ]. Therefore, the EuroSCORE system was established for estimating the impact of preoperative complications, whereas the syntax scoring system is used for estimating the impact and severity of coronary artery stenosis [ 16 , 17 ]. Anti-infection treatments are an important and common therapy during the post-operative period, and CABG patients are no exception.…”

“…EuroSCORE is a tool for predicting CABG outcomes [ 16 ]. The covariables of the present analysis were selected based on the EuroSCORE.…”