The ability of computed tomography angiography to predict 5-year mortality in the SYNTAX III REVOLUTION trial

Shinichiro Masuda, Patrick W Serruys, Saima Mushtaq, Kaoru Tanaka, Damien Mandry, Ronny R Buechel, Franck Digne, Ulrich Schneider, Giulio Pompilio, Mark La Meir, Torsten Doenst, Ulf Teichgraber, Marie-Angele Morel, Nozomi Kotoku, Kai Ninomiya, Shigetaka Kageyama, Neil O'Leary, Carlos Collet, Scot Garg, Johan de MeyDaniele Andreini, Yoshinobu Onuma

Research output: Contribution to journalArticlepeer-review


BACKGROUND: The feasibility of using coronary computed tomography angiography (CCTA) for long-term prediction of vital prognosis post-revascularization remains unknown.

OBJECTIVES: To compare the prognostic value of the SYNTAX score II 2020 (SS-2020) derived from invasive coronary angiography (ICA) or CCTA in patients with three-vessel disease and/or left main coronary artery disease undergoing percutaneous or surgical revascularization.

METHODS: In the SYNTAX III REVOLUTION trial, the probability of death at five years was retrospectively assessed by calculating the SS-2020 using ICA and CCTA. High- and low-risk patients for mortality were categorized according to the median percentages of predicted mortality based on both modalities. The discriminative abilities of the SS-2020 were assessed using Harrell's C statistic.

RESULTS: The vital status at five years of the 215 patients revascularized percutaneously (64 patients, 29.8%) or surgically (151 patients, 70.2%) was established through national registries. In patients undergoing revascularization, the SS-2020 was possibly helpful in discriminating vital prognosis at 5 years, with similar results seen with ICA and CCTA (C-index with ICA ​= ​0.75, intercept ​= ​-0.19, slope ​= ​0.92 and C-index with CCTA ​= ​0.75, intercept ​= ​-0.22, slope ​= ​0.99). In high- and low-risk patients, Kaplan-Meier estimates showed significant, and almost identical relative differences in observed mortality, irrespective of imaging modality (ICA: 93.8% vs 78.7%, log-lank P ​< ​0.001; CCTA: 93.7% vs 78.5%, log-lank P ​< ​0.001).

CONCLUSIONS: The predictive ability of the SS-2020 for five-year all-cause mortality derived from ICA and CCTA was comparable, and could helpfully discriminate vital prognosis in high- and low-risk patients.

Original languageEnglish
Article number00414
Pages (from-to)318-325
Number of pages8
JournalJournal of cardiovascular computed tomography
Issue number5
Early online date6 Sep 2023
Publication statusPublished - Oct 2023

Bibliographical note

Copyright © 2023. Published by Elsevier Inc.


  • Coronary computed tomography angiographyt
  • Invasive coronary artery
  • Predictive ability
  • SYNTAX score 2020


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