title: Direct comparison between coronary computed tomography and invasive angiography for calculation of SYNTAX score.
abstract: OBJECTIVE
  We aimed to test the feasibility of calculating SYNTAX score from coronary computed tomographic angiography (CCTA) compared to from invasive coronary angiography (ICA).
  
  
  RESULTS
  SYNTAX score was independently and blindly calculated from CCTA and from ICA in 104 patients, age 57±10, with significant (>50%) stenoses in 1.7±0.7 vessels. The level of agreement was assessed by Cohen's kappa. Agreement between ICA and CCTA for conventional vessel-based analysis (presence of >50% stenosis per vessel) was substantial with kappa=0.66 and sensitivity, specificity and accuracy of 74%, 90% and 80%, respectively. The mean SYNTAX score was 14.2±10.0 by ICA and 10.3±6.9 by CCTA, with a significant underestimation of 3.9±8.2 by CCTA (p<0.001). Weighted kappa was 0.33, indicating only fair agreement. When only good quality CCTA were included, kappa improved to 0.56. Analysis of the cause of the bias showed ICA to identify more lesions per patient (2.2±1.3 vs. 1.7±1.0, p<0.001), while the mean score per lesion was not different (6.4 vs. 5.9, p=ns).
  
  
  CONCLUSIONS
  CCTA, despite having a good agreement with ICA by conventional vessel-based analysis, showed only fair agreement for the calculation of SYNTAX score, and cannot be currently used as a substitute for diagnostic ICA for this purpose.
authors.affiliation: Cardiology Department, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Arthur
authors.initials: A
authors.lastname: Kerner
authors.forename: Sobhi
authors.initials: S
authors.lastname: Abadi
authors.forename: Eitan
authors.initials: E
authors.lastname: Abergel
authors.forename: Amir
authors.initials: A
authors.lastname: Solomonica
authors.forename: Doron
authors.initials: D
authors.lastname: Aronson
authors.forename: Ariel
authors.initials: A
authors.lastname: Roguin
authors.forename: Jonathan
authors.initials: J
authors.lastname: Lessick
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index