Adam Brzeski

Aleksandra Gasecka

Ewelina Blazejowska

Jakub Michal Zimodro

Jaroslaw Parzuchowski

Radoslaw Targonski

Tomasz Dziubich

Tomasz Figatowski

Cardiology Journal

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Address for correspondence: Radoslaw Targonski, MD, PhD, 1st Department of Cardiology, Medical University of Gdansk, ul. Dębinki 7, 80–952 Gdańsk, Poland, e-mail: rtargonski@gmail.comReceived: 10.05.2023 Accepted: 27.09.2023 Early publication date: 29.09.2023This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.Cardiology Journal2023, Vol. 30, No. 5, 846–848DOI: 10.5603/cj.95508Copyright © 2023 Via MedicaISSN 1897–5593eISSN 1898–018XTECHNOLOGY NOTEINTERVENTIONAL CARDIOLOGYAngioScore: An artificial intelligence  tool to assess coronary artery lesionsEwelina Blazejowska1 , Jakub Michal Zimodro1 , Tomasz Figatowski2 ,  Adam Brzeski3 , Tomasz Dziubich3, Jaroslaw Parzuchowski3,  Aleksandra Gasecka1 , Radoslaw Targonski211st Chair and Department of Cardiology, Medical University of Warsaw, Poland21st Department of Cardiology, Medical University of Gdansk, Poland3Faculty of Electronics, Telecommunications and Informatics, Department of Computer Architecture,  Gdansk University of Technology, Gdansk, PolandCoronary artery disease (CAD) is a serious clin-ical and economic problem, constituting the leading cause of mortality [1–3]. Interventional treatment of CAD includes percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or a combination of both, depending on the anatomical complexity and clinical presentation. The Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score (SS) is an angiography-based scale to quantify the sever-ity of CAD and to determine optimal treatment in patients with left main or multivessel disease [4]. PCI is a preferable treatment in patients with low SS. In contrast, patients with high SS are eligible for CABG, as higher SS is associated with greater risk and worse PCI outcome [5, 6].Although SS remains the most accurate scale to determine treatment strategy and prognosis, it has several limitations. SS is based solely on angiographic findings, while consideration of frac-tional flow reserve would improve revasculariza-tion strategy [7]. Currently, SS is calculated using online tools, e.g., syntaxscore.org. The evaluation process is subjective, depends on the experience of the investigator, and requires manual input of all SS parameters. To facilitate SS calculation, we developed an artificial intelligence-based web application, AngioScore, to calculate SS semi-automatically and objectively.To test AngioScore in assessment of SS pa-rameters (diseased segment, total occlusion, bi-furcation, trifurcation, aorto-ostial lesion, severe tortuosity, length > 20 mm, heavy calcification, and thrombus) two investigators evaluated 100 ran-domly selected coronary artery lesions. Coronary angiograms were exported in DICOM format and uploaded them to AngioScore. The investigators chose the dominant (right or left) coronary artery and marked the lesions with a coloured brush. Subsequently, AngioScore determined initial SS (Fig. 1). Then, the investigators identified and corrected the parameters that required manual revision. These parameters were recorded in the table. To determine the preliminary accuracy of AngioScore in lesion assessment, statistical analy-sis was performed using Statistica (13.3 version, StatSoft, Krakow, Poland).Nineteen percent of the lesions were assessed fully and correctly. Of the remaining lesions, 34% required correction of 1 of 9 parameters, 31% — 2 parameters, 14% — 3 parameters, and 2% — 4 or more parameters (Fig. 2). The median number of required corrections was 1 ± 1.04. Incorrectly as-sessed lesions were in the left anterior descending artery, the right coronary artery, and the circum-flex branch of the left coronary artery (39.51% vs. 30.86% vs. 29.63%, respectively). The parameters that most often required corrections were: dis-846 www.cardiologyjournal.orgeased segment (37.4%), bifurcation (22.4%), and severe tortuosity (15.6%). AngioScore seems a cost-effective, scalable, interactive and user-friendly tool, which could be applied in teamwork and teaching trainees to recognize angiographic projections, and to find and assess coronary artery lesions. It has a potential to reduce variability and improve consistency in SS calculation. However, further development is required in terms of (i) high dependence on the quality of coronary angiogram, and (ii) limited abil-ity to identify the location, bifurcation and severe tortuosity of the lesion. In further investigations, a greater number of coronary artery lesions must be assessed to improve the accuracy of AngioScore in lesion assessment. Subsequently, AngioScore should be evaluated in comparison to online SS calculators regarding the time needed to assess one coronary angiogram. Moreover, AngioScore sensitivity and specificity in evaluation of particular SS parameters must be determined.Altogether, the prototype of AngioScore showed promising results regarding the accuracy in assessment of coronary artery lesions. Thereby, AngioScore may be the first tool dedicated to ef-ficient and objective SS calculation.Conflict of interest: None declaredReferences1. Ralapanawa U, Sivakanesan R. Epidemiology and the magnitude of coronary artery disease and acute coronary syndrome: a nar-Figure 1. AngioScore interface. Screenshot showing: (i) the right coronary artery lesion (marked with red brush), (ii) nine semi-automatically set SYNTAX Score parameters, and (iii) automatically set initial SYNTAX Score (marked with red arrow).34%31%14% 19%Full correctlyCorrection in 1 of 9 parametersCorrection in 2 of 9 parametersCorrection in 3 of 9 parametersCorrection in 4 or more parametersFigure 2. Percentage of lesions that required manual correction; 19% — no correction needed (blue bar), 34% — correction in 1 of 9 parameters (orange bar), 31% — correction in 2 of 9 parameters (gray bar), 14% — correction in 3 of 9 parameters (green bar), 2% — correction in 4 or more parameters (white bar). www.cardiologyjournal.org 847Ewelina Blazejowska et al., AngioScore for the assessment of coronary artery lesionsrative review. J Epidemiol Glob Health. 2021; 11(2): 169–177, doi: 10.2991/jegh.k.201217.001, indexed in Pubmed: 33605111.2. Barquera S, Pedroza-Tobías A, Medina C, et al. Global over-view of the epidemiology of atherosclerotic cardiovascular dis-ease. Arch Med Res. 2015; 46(5): 328–338, doi: 10.1016/j.arc-med.2015.06.006, indexed in Pubmed: 26135634.3. Duggan JP, Peters AS, Trachiotis GD, et al. Epidemiology of coro-nary artery disease. Surg Clin North Am. 2022; 102(3): 499–516, doi: 10.1016/j.suc.2022.01.007, indexed in Pubmed: 35671770.4. Zhang R, Song C, Guan C, et al. Prognostic value of quantitative flow ratio based functional SYNTAX score in patients with left main or multivessel coronary artery disease. Circ Cardiovasc Interv. 2020; 13(10): e009155, doi: 10.1161/CIRCINTERVEN-TIONS.120.009155, indexed in Pubmed: 33040580.5. Morice MC, Serruys P, Kappetein A, et al. Outcomes in patients with de novo left main disease treated with either percuta-neous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the synergy between percutaneous coronary intervention with TAXUS and cardiac surgery (SYNTAX) trial. Circulation. 2010; 121(24): 2645–2653, doi: 10.1161/circulationaha.109.899211, indexed in Pubmed: 20530001.6. Bundhun PK, Bhurtu A, Huang F. Worse clinical outcomes fol-lowing percutaneous coronary intervention with a high SYNTAX score: a systematic review and meta-analysis. Medicine (Balti-more). 2017; 96(24): e7140, doi: 10.1097/MD.0000000000007140, indexed in Pubmed: 28614240.7. Novara M, D’Ascenzo F, Gonella A, et al. Changing of SYNTAX score performing fractional flow reserve in multivessel coronary artery disease. J Cardiovasc Med (Hagerstown). 2012; 13(6): 368–375, doi: 10.2459/JCM.0b013e3283536adc, indexed in Pub-med: 22499002.848 www.cardiologyjournal.orgCardiology Journal 2023, Vol. 30, No. 5

AngioScore: An artificial intelligence tool to assess coronary artery lesions

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AngioScore: An artificial intelligence tool to assess coronary artery lesions

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