Dive Brief:

• Advancements in imaging technology support the potential for CT scans to become a non-invasive alternative to angiography for diagnosing complex coronary artery disease (CAD), suggests a new study published in the European Heart Journal.
• The multicenter study, called Syntax III Revolution, found that a heart team’s treatment recommendations based on a CT scan from the GE Healthcare Revolution 512 slice system were in high agreement with a separate team making its decision based on conventional angiography.
• The study of 223 patients was conducted by Cardialysis, a clinical research organization, on behalf of the European Cardiovascular Research Institute (ECRI), and was funded by GE Healthcare and medtech company HeartFlow.

Dive Insight:

A traditional coronary angiogram requires a catheter to be threaded through the groin or arm to the heart to check for narrowed or blocked arteries. Computed tomography angiography (CTA) is increasingly being used to produce images of the heart and its blood vessels as a noninvasive diagnostic method for patients with suspected coronary artery disease.

The Syntax study sought to investigate the effectiveness of CTA in diagnosing complex forms of coronary artery disease. The study looked at patients with left main or three vessel disease, considered the most severe CAD diagnoses.

Two separate teams consisting of an interventional cardiologist, cardiac surgeon and radiologist were randomized to evaluate patients’ coronary artery disease with either CTA or conventional angiography. Each heart team, blinded for the other modality, quantified the anatomical complexity to provide a treatment recommendation based on mortality prediction at four years. Decisions were either coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or either.

The primary endpoint was the agreement between heart teams on the revascularization strategy. The results showed treatment decisions between the two teams were in high agreement. A treatment recommendation of CABG was made in 28% of the cases with coronary CTA and 26% with conventional angiography. The heart teams agreed on the coronary segments to be revascularized in 80% of the cases.

After reviewing the trial’s results, 84% of cardiac surgeons who participated in the study agreed planning surgery based on the CT scan is viable. Cardialysis will follow up with a new study to test the safety of CABG surgery for left main or three vessel disease using only the data from the multislice CT scan.

“In the next five to 10 years, with its increasing accuracy, I think we are going to see the new generation of multislice CT scans play an increasingly important role in diagnosing and treating CAD,” Patrick W. Serruys, principal investigator for the study and professor at the Imperial College of London, said in a press release. “It will take time and it will take multiple trials, but the results of our Syntax III trial suggest a promising, real change in our practice.