Correlation of Coronary CT Angiography with Invasive Coronary Angiography: A Comparison of CT-Adapted Leaman Score with ICA-Based SYNTAX Score in Guiding Revascularization
TL;DR
The 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.
Abstract
Abstract Background 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. Objectives 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]). Materials and Methods 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. Results 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. Conclusions 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.