Evidence map›Paper›PMID 34542612›Full record

Trial reportInteractive cardiovascular and thoracic surgery2022

Impact of coronary calcification assessed by coronary CT angiography on treatment decision in patients with three-vessel CAD: insights from SYNTAX III trial.

Daniele Andreini, Kuniaki Takahashi, Saima Mushtaq, Edoardo Conte, Rodrigo Modolo, Jeroen Sonck, Johan De Mey, Paolo Ravagnani, Danny Schoors, Francesco Maisano and 11 more

Abstract readMulticenter StudyRandomized Controlled Trial
In one paragraph

Trial report in Interactive cardiovascular and thoracic surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. The REVOLUTION project: planning and performing surgical revascularization based solely on coronary computed tomography angiography.European heart journal supplements : journal of the European Society of Cardiology · 2025
    Article
  3. Article
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

21 authors.

Daniele AndreiniDepartment of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Kuniaki TakahashiDepartment of Cardiology, Amsterdam University Medical Center, Amsterdam, Netherlands.ORCID 0000-0001-5748-7700
Saima MushtaqDepartment of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Edoardo ConteDepartment of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy.ORCID 0000-0003-1443-5788
Rodrigo ModoloDepartment of Cardiology, Amsterdam University Medical Center, Amsterdam, Netherlands.ORCID 0000-0002-0047-7859
Jeroen SonckCardiovascular Center Aalst, OLV Hospital, Aalst, Belgium.
Johan De MeyUniversitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussel, Belgium.
Paolo RavagnaniDepartment of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy.ORCID 0000-0003-2368-337X
Danny SchoorsUniversity of Zurich, Zurich, Switzerland.
Francesco MaisanoUniversity of Zurich, Zurich, Switzerland.
Philipp KaufmannUniversity of Zurich, Zurich, Switzerland.
Wietze LindeboomCardialysis BV, Rotterdam, Netherlands.
Marie-Angele MorelCardialysis BV, Rotterdam, Netherlands.
Torsten DoenstJena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany.
Ulf TeichgräberJena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany.
Gianluca PontoneDepartment of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy.ORCID 0000-0002-1339-6679
Giulio PompilioDepartment of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Antonio BartorelliDepartment of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Yoshinobu OnumaThoraxcenter, Erasmus MC, Rotterdam, Netherlands.
Patrick W SerruysDepartment of Cardiology, Royal Brompton and Harefield Hospitals, Imperial College London, London, UK.
Syntax III Revolution Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesThe aim of this study was to determine Syntax scores based on coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) and to assess whether heavy coronary calcification significantly limits the CCTA evaluation and the impact of severe calcification on heart team's treatment decision and procedural planning in patients with three-vessel coronary artery disease (CAD) with or without left main disease.

methodsSYNTAX III was a multicentre, international study that included patients with three-vessel CAD with or without left main disease. The heart teams were randomized to either assess coronary arteries with coronary CCTA or ICA. We stratified the patients based on the presence of at least 1 lesion with heavy calcification defined as arc of calcium >180° within the lesion using CCTA. Agreement on the anatomical SYNTAX score and treatment decision was compared between patients with and without heavy calcifications.

resultsOverall, 222 patients with available CCTA and ICA were included in this trial subanalysis (104 with heavy calcification, 118 without heavy calcification). The mean difference in the anatomical SYNTAX score (CCTA derived-ICA derived) was lower in patients without heavy calcifications [mean (-1.96 SD; +1.96 SD) = 1.5 (-19.3; 22.4) vs 5.9 (-17.5; +29.3), P = 0.004]. The agreement on treatment decision did not differ between patients with (Cohen's kappa 0.79) or without coronary calcifications (Cohen's kappa 0.84). The agreement on the treatment planning did not differ between patients with (concordance 80.3%) or without coronary calcifications (concordance 82.8%).

conclusionsAn overall good correlation between CCTA- and ICA-derived Syntax score was found. The presence of heavy coronary calcification moderately influenced the agreement between CCTA and ICA on the anatomical SYNTAX score. However, agreement on the treatment decision and planning was high and irrespective of the presence of calcified lesions.

Indexed as

Coronary Artery DiseaseCoronary StenosisComputed Tomography AngiographyCoronary AngiographyHumansPredictive Value of TestsTomography, X-Ray ComputedCoronary calcificationCoronary computed tomography angiographyHeart team

Identifiers

PMID34542612
PMCPMC8766208

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.