This website uses cookies to store information on your computer. Some of these cookies are used for visitor analysis, others are essential to making our site function properly and improve the user experience. By using this site, you consent to the placement of these cookies. Click Accept to consent and dismiss this message or Deny to leave this website. Read our Privacy Statement for more.
Careers | Join | SCCT Connect | Print Page | Report Abuse | Sign In
News & Press: News

New research modifies SYNTAX score to non-invasive CCTA modality

Wednesday, October 25, 2023   (0 Comments)
Posted by: Jessica Frizen
SAN FRANCISCO, CA (October 25, 2023) – Investigators have developed and effectively used an updated anatomical CT-SYNTAX scoring tool in a cohort of patients with complex coronary artery disease (CAD) who underwent coronary artery bypass graft surgery (CABG), with planning and execution solely guided by coronary computed tomography angiography (CCTA).
The results have been simultaneously published online in the Journal of Cardiovascular Computed Tomography (JCCT) with a presentation at the Transcatheter Cardiovascular Therapeutics (TCT) annual scientific conference of the Cardiovascular Research Foundation (CRF), currently taking place in San Francisco, Calif.
JCCT Editor-in-Chief Armin Zadeh, MD, PhD, MPH, MSCCT said using this tool noninvasively by CT may allow better decisions for patients, possibly reducing risk and costs.
“The expected impact of this paper will be more widespread use of this tool to guide management of patients with coronary artery disease with the hope of better patient outcomes,” said Zadeh. “Specifically, the tool was refined for defining total vessel occlusions, heavy calcification, and diffuse disease. Previous versions of this tool were somewhat vague in that regard, leading to variability of interpretation.”
According to the writing group, the original SYNTAX score was established in 2005 for invasive coronary angiography (ICA-SYNTAX) and was evaluated in the SYNTAX trial in 2009 to semi-quantify the lesion complexity and ischemic myocardial mass.
“This manuscript is important because CCTA is different from ICA and therefore, the original SYNTAX score cannot simply be applied to CCTA,” said Patrick Serruys, MD, PhD, corresponding author. “The new CCTA-SYNTAX score clearly answers how to appropriately calculate the SYNTAX score with visual guidance. This manuscript is the official modification of the anatomical SYNTAX score for the first time in 18 years.”
The authors explained that the first report on the adaptation of the fluoroscopic anatomic CT-SYNTAX score was introduced in JACC: Cardiovascular Imaging in 2013, followed by over 45 published reports translating SYNTAX to the non-invasive modality.
“Since the initial attempt in 2013 to adapt the anatomic SYNTAX score to CCTA, the technology of CCTA imaging has evolved, resulting in greater feasibility of assessment of complex coronary artery disease by reducing motion artefacts and blooming artefacts. Therefore, the current CCTA-SYNTAX score calculation needs to be updated,” Serruys explained.
The new CT-SYNTAX score brings the cardiac imaging community closer to its goal of predicting cardiac events and mortality solely with non-invasive CCTA data, especially with an increased interest in AI, deep learning and an automated assessment of the score, the paper states.
“SYNTAX score was proven to have an impact on cardiovascular mortality. As AHA/ESC guidelines recommend, calculating the SYNTAX score and choosing the optimal revascularization mode in the Heart Team discussion is the state-of-the-art approach,” said First Author Shigetaka Kageyama, MD, cardiologist and clinical researcher at the University of Galway, Ireland.
He said that with CCTA replacing ICA and the potential of artificial intelligence, the CT-SYNTAX score becomes an easy, non-invasive tool to support CCTA as the first line of diagnosis for complex CAD patients.
Top takeaways from the authors include:
  • The presence of total occlusion (TO) in CCTA is further characterized by length criteria that improve the accuracy of detection with respect to conventional ICA.
  • The CCTA score accounts for narrowings of more than 50% involved in serial bifurcation/trifurcations and multiple TOs in the same coronary segment. Of note, this point is applied to the ICA-SYNTAX score modification as well.
  • Lesions located behind a TO assessable on CCTA are included in the score, whilst they are usually not scored on conventional invasive coronary angiography since they are not reliably visualized. In conventional cine angiography the duration of injection, the amount of contrast medium injected and the duration of cine filming may impact the visualization of the distal bed due to incomplete opacification through collaterals.
###
About the Society of Cardiovascular Computed Tomography
Founded in 2005, the Society of Cardiovascular Computed Tomography (SCCT) is the international professional society devoted to improving health outcomes through effective use of cardiovascular computed tomography (CCT). SCCT is a community of physicians, scientists and technologists from over 85 countries advocating for access, research, education and clinical excellence in the use of CCT. For more information, please visit www.SCCT.org.
About the Journal of Cardiovascular Computed Tomography
The Journal of Cardiovascular Computed Tomography (JCCT) is a peer-review journal of the SCCT that integrates the international cardiovascular CT community and addresses a broad range of topics affecting cardiovascular CT imaging. The journal’s major focus is on original research and on the clinical and technical aspects of cardiovascular CT. For more information, please visit www.journalofcardiovascularct.com.
###

« Back to Index