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

Figures

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  Fig. 1. Representative case of SYNTAX score 2020 calculation. A 74-year-old man with creatinine clearance of 60 ml/min and LVEF of 45%. The anatomical SYNTAX score derived from ICA is 38.5, and from CCTA is 43.0. Predicted 10-year all-cause mortality based on ICA with PCI and CABG are estimated to be 42.7% and 27.4%, respectively. Alternatively, predicted 10-year mortality with PCI and CABG based on CCTA are estimated to be 45.1% and 27.4% respectively. Individual ARD was estimated to be 17.7% on ICA (42.7% [all-cause mortality with PCI] − 27.4% [all-cause mortality with CABG]) and 15.3% on CCTA (45.1–27.4%). Based on these findings, CABG is recommended by both ICA and CCTA. ARD absolute risk difference, CABG coronary artery bypass graft, CrCL creatinine clearance, CCTA coronary computed tomography angiography, COPD chronic obstructive pulmonary disease, DM diabetes mellitus, ICA invasive coronary angiography, LMCAD left main coronary artery disease, LVEF left ventricular ejection fraction, PCI percutaneous coronary intervention, PVD peripheral vascular disease

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  Fig. 2. Treatment recommendation according to the individual predicted absolute risk difference. Predicted mortality after either PCI (blue dots) or CABG (red dots) for each patient (individual scatterplots). CABG is recommended for 43.9% of the population on CCTA (A), and 35.1% on ICA (B) for 5-year mortality. Similarly, CABG is recommended for 73.7% of the population on CCTA (C), and 64.9% on ICA (D) for 10-year mortality. ARD absolute risk difference, CABG coronary artery bypass graft, CCTA coronary computed tomography angiography, ICA invasive coronary angiography, PCI percutaneous coronary intervention

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  Fig. 3. Scatter plots of individual absolute risk difference between two modalities. Scatter plots between the two modalities for 5-year (A) and 10-year all-cause mortality (B) according to the personalized SYNTAX score 2020. The orange line shows the regression line, and the orange dotted line shows absolute risk difference of 4.5%. Orange areas show diagnostic agreement between the two modalities. The agreements of treatment recommendations among the two modalities are 84.2% for 5-year (A), and 80.7% for 10-year all-cause mortality (B). ARD absolute risk difference, CCTA coronary computed tomography angiography, ICA invasive coronary angiography

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  Fig. 4. Agreement of absolute risk difference between two modalities. Bland–Altman analysis between absolute risk difference derived from invasive coronary angiography and coronary computed tomography angiography for 5-year (A), and 10-year all-cause mortality (B). Black line shows the mean difference, and the orange dotted lines show 95% CI. ARD absolute risk difference, CCTA coronary computed tomography angiography, ICA invasive coronary angiography