Correlation of Coronary CT Angiography with Invasive Coronary Angiography: A Comparison of CT-Adapted Leaman Score with ICA-Based SYNTAX Score in Guiding Revascularization

The invasive coronary angiography (ICA)-based SYNTAX score is well established for grading coronary artery disease complexity and guiding revascularization. Coronary computed tomography angiography (CCTA) offers noninvasive assessment of coronary anatomy, and a CT-adapted Leaman score (CT-LeSc) has already been proposed to quantify total atherosclerotic burden. To evaluate the correlation between CT-LeSc and ICA-based SYNTAX score and to analyze the ability of CT-LeSc in guiding revascularization (percutaneous coronary intervention [PCI] vs. coronary artery bypass grafting [CABG]). This prospective, single-center study included 30 patients with >50% stenosis on CCTA who subsequently underwent both ICA and revascularization. CT-LeSc and ICA-SYNTAX scores were calculated and statistically compared using correlation analysis and receiver operating characteristic (ROC) curve analysis. A total of 30 patients (mean age ∼55.2 years, standard deviation 10.3, range 35–75, 23 (77%) male) with ≥50% stenosis on CCTA who subsequently underwent ICA and revascularization were analyzed. The mean total CT-LeSc was 7.81 ± 3.28, while mean ICA-SYNTAX was 13.9 ± 8.4. A scatter plot showed a strong positive correlation between CT-LeSc and ICA-SYNTAX (r = 0.780, p < 0.001; R 2 ≈ 0.61). CT-LeSc effectively discriminated revascularization strategy: ROC analysis gave an area under the curve of 0.935 (p = 0.001) for identifying patients needing CABG, with a CT-LeSc cut-off ≥9.42 yielding 85.7% sensitivity and 86.9% specificity. Notably, high CT-LeSc values (≥ 9.42) had a 95.2% negative predictive value for CABG. CT-LeSc demonstrates strong correlation with the ICA-SYNTAX score. Our findings suggest that CCTA-derived CT-LeSc serves as an effective noninvasive marker of anatomical complexity in coronary artery disease, facilitating revascularization planning (PCI vs. CABG) with high accuracy.