SYNTAX and Coronary Artery Calcium Score Predict Atherosclerotic Plaque Formation in the Ascending Aorta

Association between SYNTAX Score and Atherosclerosis in Ascending Aorta


  • Ismail Haberal Department of Cardiovascular Surgery, İstanbul University – Cerrahpasa, Institute of Cardiology, İstanbul, Turkey
  • Mehmet Balli Department of Cardiology, Mersin City Training and Research Hospital, Mersin, Turkey
  • Esra Erturk Tekin Department of Cardiovascular Surgery, Mersin City Training and Research Hospital, Mersin, Turkey
  • Ayhan Uysal Department of Cardiovascular Surgery, Firat University Medical Faculty, Elazig, Turkey
  • Sadiye Deniz Ozsoy Department of Cardiovascular Surgery, İstanbul University – Cerrahpasa, Institute of Cardiology, İstanbul, Turkey
  • Mehmet Ali Yesiltas Department of Cardiovascular Surgery, Health Ministry Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
  • Dogaç Oksen Department of Cardiology, İstanbul University – Cerrahpasa, Institute of Cardiology, İstanbul, Turkey
  • Sebnem Batur Department of Pathology, İstanbul University, İstanbul University Cerrahpaşa Medical Faculty, İstanbul, Turkey
  • Hulya Yilmaz Ak Department of Anesthesiology and Reanimation, İstanbul University - Cerrahpasa, Institute of Cardiology, İstanbul, Turkey
  • Bahar Aydinli Department of Anesthesiology and Reanimation, Mersin City Training and Research Hospital, Mersin, Turkey



SYNTAX, coronary artery calcific score, aortic stiffness, coronary artery by-pass grafting, complications


Background: There is no study about the relationship between the complexity of coronary artery disease (SYNTAX SCORE; SS), and coronary artery calcium (CAC) score, accompanied with aortic calcium score (ACS) levels. The objective of this study was to investigate the relationship between the preoperative SS and CAC scores accompanying ACS in isolated CABG patients and their postoperative clinical results.

Methods: This study included 130 consecutive CABG patients. The mean age of the patients was 62.3 ± 8.62 years (range: 47-84 years). SS was measured using coronary angiography by an experienced cardiologist. We investigated the ACS accompanied with CAC scores using a multidetector computed tomography (MDCT) in the same session, preoperatively. Measurements of the CAC score and ACS were measured by an experienced radiologist, who was unaware of the study in the same session. In order to investigate aortic wall pathology in patients with positive aortic calcification, we provided aortic tissue samples prior to the proximal anastomosis of bypass grafts using No:11 scalpel.

Results: Overall median SS was 39 ± 7.2 (range: 15-41). CAC score was zero in 34 patients (26.1%). For the patients with a CAC score of zero, the median SS was 32 ± 9.4. There was no evidence of aortic calcification or plaque formation in 62 patients (47.6%). In these patients, the median SS was 35.6 ± 11.3. No significant difference was found when both groups were compared and for those patients with a calcific score of zero (P = .85). The median CAC score and ACS were 238 ± 122 AU (range: 0-1238 AU) and 112 ± 40 AU (range: 0-730 AU), respectively (P = .0033). For patients with a CAC score and ACS ≥400 AU, the mean SYNTAX score was ≥ 37. SS was correlated with CAC score (R:0.585; P < .0001). SYNTAX was correlated with ACS (R:0.557; P < .001). In multivariate analysis of SS (OR 1.053, 95% CI: 1.003–1.106, P = .039), gender (OR 0.189, 95% CI: 0.053–0.678, P = 0.011), age (OR 1.454, 95% CI: 1.256–1.632, P = .012), and diabetes mellitus (OR 0.341, 95% CI: 1.006–1.124, P = .014) were independent predictors for CAC score and aortic calcification.

Conclusions: CAC score and ACS are strongly correlated with the complexity of coronary arteries in CABG patients. The total CAC score (≥ 400 AU) was independently associated with the degree of SS (>37). To prevent MACCE and mortality in CABG patients, we suggest the measurement of CAC score accompanied with ACS using MDCT as a non-invasive method.

Highlight points:

• Atherosclerotic plaque formation in aorta and coronary arteries are the main risk factors for stroke and infarction in CABG operations.

•SYNTAX score value and aortic atherosclerosis levels are directly correlated.

•SYNTAX score may predict the complications due to atherosclerosis during heart surgery.


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How to Cite

Haberal, I., Balli, M., ertürk tekin, esra, Uysal, A., Deniz Ozsoy, S., Yesiltas, M. A. ., Oksen, D., Batur, S., Ak, H. Y. ., & Aydinli, B. (2021). SYNTAX and Coronary Artery Calcium Score Predict Atherosclerotic Plaque Formation in the Ascending Aorta: Association between SYNTAX Score and Atherosclerosis in Ascending Aorta. The Heart Surgery Forum, 24(6), E996-E1004.