Prognostic Implication of a CT-FFR-Based Functional SYNTAX Score in Coronary Artery Disease Patients Undergoing Percutaneous Coronary Intervention.
Authors
Affiliations (3)
Affiliations (3)
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
- Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, SC 29425, USA.
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Abstract
<b>Background</b>: This study aims to investigate the value of a SYNTAX score (SS) based on coronary computed tomographic angiography (cCTA)-derived fractional flow reserve (CT-FFR), termed "Functional SYNTAX score" (FSS<sub>CTA</sub>), to predict major adverse cardiovascular events (MACEs) in patients undergoing percutaneous coronary intervention (PCI). <b>Methods</b>: This cohort study included 876 patients who underwent cCTA and underwent PCI within 30 days during 2016-2020. CT-FFR was calculated by a machine learning algorithm. All 876 patients were divided into a low-risk group (≤22) and an intermediate-to-high-risk group (>22) with cCTA-based SS (SS<sub>CTA</sub>) as the control. <b>Results:</b> Based on the FSS<sub>CTA</sub>, 10.4% (91/876) of patients were reclassified to the low-risk group, and 2.9% (25/876) of patients were reclassified to the intermediate-to-high-risk group. MACEs occurred in 16.6% (145/876) of patients over a median follow-up period of 19.4 months. FSS<sub>CTA</sub> and invasive coronary angiography-based SS (SS<sub>ICA</sub>) were independently associated with the risk of MACEs regardless of whether they were in continuous or categorical form (FSS<sub>CTA</sub>: c continuous HR 1.082, 95% CI 1.038-1.128; categorical HR 1.865, 95% CI 1.138-2.305. SS<sub>ICA</sub>: continuous HR 1.045, 95% CI 1.012-1.079; categorical HR 1.520, 95% CI 1.128-2.048). FSS<sub>CTA</sub> showed the best predictive power for MACEs compared with SS<sub>CTA</sub> and SS<sub>ICA</sub> (all comparisons with FSS<sub>CTA</sub><i>p</i> < 0.05). <b>Conclusions</b>: FSS<sub>CTA</sub>, SS<sub>CTA</sub> and SS<sub>ICA</sub> were all independent predictors of MACEs in patients undergoing PCI, and FSS<sub>CTA</sub> showed a significantly better predictive value for MACEs than SS<sub>CTA</sub> and SS<sub>ICA</sub>.