Cardiology Department, Rambam Health Care Campus, Haifa, Israel.
EuroIntervention. 2013 Apr 22;8(12):1428-34. doi: 10.4244/EIJV8I12A216.
We aimed to test the feasibility of calculating SYNTAX score from coronary computed tomographic angiography (CCTA) compared to from invasive coronary angiography (ICA).
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).
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.
我们旨在测试通过冠状动脉计算机断层扫描血管造影（CCTA）计算 SYNTAX 评分与通过有创冠状动脉造影（ICA）计算 SYNTAX 评分的可行性。
在 104 例年龄为 57±10 岁、有 1.7±0.7 支血管狭窄程度超过 50%的患者中，独立、盲法地通过 CCTA 和 ICA 计算了 SYNTAX 评分。通过 Cohen's kappa 评估一致性水平。通过 CCTA 和 ICA 对常规基于血管的分析（每支血管存在>50%狭窄）进行一致性评估为中等程度，kappa 值为 0.66，敏感性、特异性和准确性分别为 74%、90%和 80%。ICA 的平均 SYNTAX 评分为 14.2±10.0，CCTA 的平均 SYNTAX 评分为 10.3±6.9，CCTA 明显低估了 3.9±8.2（p<0.001）。加权 kappa 值为 0.33，表明仅为适度一致性。当仅纳入高质量 CCTA 时，kappa 值提高到 0.56。对偏差原因的分析表明，ICA 每例患者识别的病变更多（2.2±1.3 与 1.7±1.0，p<0.001），而每个病变的平均评分无差异（6.4 与 5.9，p=ns）。
尽管 CCTA 通过常规基于血管的分析与 ICA 具有良好的一致性，但在计算 SYNTAX 评分方面仅具有适度的一致性，目前不能作为替代有创 ICA 的方法用于此目的。
