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SYNTAX III REVOLUTION Trial: A Randomized Study Investigating the Use of CT Scan and Angiography of the Heart to Help the Doctors Decide Which Method is the Best to Improve Blood Supply to the Heart in Patients With Complex Coronary Artery Disease (SYNTAX III)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02813473
Recruitment Status : Completed
First Posted : June 27, 2016
Last Update Posted : December 10, 2018
GE Healthcare
HeartFlow, Inc.
Information provided by (Responsible Party):

Brief Summary:

The SYNTAX III Revolution trial is a randomized diagnostic research study that investigates the use of CT scan and angiogram of the heart to help doctors decide which method is the best to improve blood supply to the heart in patients with complex coronary artery disease. Each patient will undergo an angiogram and CT scan per standard of care. The randomization strategy in this study is not between patients but between two teams of doctors, the so-called "Heart Teams", will be randomized: in the first round, team 1 assesses the angiogram, and team 2 assesses the CT scan. Then they make a decision about which treatment would be the best to treat complex coronary artery disease. In the second round, both teams see the imaging method that they did not see in the first round, and make the decision again. The final decision on the clinical treatment strategy is at the sole discretion of the Heart Team and there are no criteria described in SYNTAXIII Revolution protocol leading influencing this final decision.

Hypothesis: Determination of the best treatment strategy for coronary artery disease based on a CT scan will result in similar decisions as based on invasive coronary angiography.

Condition or disease Intervention/treatment
Coronary Artery Diseases Multivessel Coronary Artery Disease Heart Diseases Cardiovascular Diseases Radiation: Coronary Angiography Radiation: Computed Tomography (CT) scan

Detailed Description:

The SYNTAX III REVOLUTION Trial is a multicenter, all-comers trial (either isolated unprotected left-main or 3-vessel disease with or without left-main disease and candidate for either CABG or PCI treatment). In SYNTAXIII REVOLUTION a diagnostic coronary angiography and a diagnostic coronary Multislice CT are performed to allow the Heart Team to assess the optimal revascularization strategy. In a normal hospital setting the angiography is considered standard of care. The multislice CT can already also be part of the diagnosis and is at the discretion of the physician. After the images of both modalities are available, the patient will no longer participate in the trial. Next step is randomization of Heart Team A and Heart B to the sequence of availability of images, i.e. randomizing whether Heart Team A will review the angiography first or the multislice CT and, automatically, Heart B the other modality. The Heart Teams need to make a decision between surgical or percutaneous treatment according to either the conventional angiography or the multislice CT angiography assessment. In addition, the incremental value of FFRCT in the decision making of the Heart Team arm allocated primarily to the assessment of the MSCT (CT first algorithm) will be a secondary endpoint. No intervention to the patient's treatment takes place


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Study Type : Observational
Actual Enrollment : 223 participants
Observational Model: Case-Only
Time Perspective: Cross-Sectional
Official Title: SYNTAX III REVOLUTION Trial: A Randomized Study to Evaluate the Feasibility of Heart-Team Clinical Decision Making Regarding the Optimal (Surgical or Percutaneous Based) Revascularization Strategy in Patients With Complex Coronary Artery Disease, Based on Non-invasive Coronary CT Angiography (CTA) Imaging Utilising High-definition GE RevolutionTM Multi-slice CT and HeartFlow FFRCT Compared to the Current Standard of Care With Conventional Invasive Coronary Angiography (CA)
Actual Study Start Date : June 27, 2016
Actual Primary Completion Date : March 26, 2018
Actual Study Completion Date : March 26, 2018

Resource links provided by the National Library of Medicine

Intervention Details:
  • Radiation: Coronary Angiography
    Coronary angiography is an X-ray test to diagnose diseases of the arteries that supply blood to the heart. Coronary angiography can detect weakened blood vessel walls and narrowed or blocked vessels. X-rays are taken after a special dye has been injected into the bloodstream, making the vessels and blood flow through the vessels visible on X-rays.
    Other Names:
    • Angiogram
    • Coronary angiogram
  • Radiation: Computed Tomography (CT) scan
    A CT scan is an X-ray imaging technique that uses a computer to produce cross-sectional images. It can be used to examine the heart and blood vessels for problems
    Other Names:
    • Cardiac computed tomography
    • Multi-Slice CT scan (MSCT)

Primary Outcome Measures :
  1. Similarity in decision making of optimal treatment based on "CT first" or "angiography first" at screening [ Time Frame: Nov 2017 ]
    Description: Inter-rater agreement, as assessed by Cohen's Kappa, on revascularization strategy of two Heart Teams using an "Angio-first" algorithm (based on invasive SYNTAX Score II) or a "CT-first" algorithm (based on non-invasive SYNTAX Score II, without FFRCT).

Secondary Outcome Measures :
  1. Level of agreement in the decision making strategy based on CT only without functional assessment and the decision making strategy based on CT with functional assessment ("CT first" algorithm group) at screening. [ Time Frame: Nov 2017 ]
  2. Level of agreement in the decision making strategy based on CT only (with functional assessment) and the decision making strategy based on CT with functional assessment and conventional angiography ("CT first" algorithm group) at screening [ Time Frame: Nov 2017 ]
  3. Level of agreement in the decision making strategy based on conventional angiography only and the decision making strategy based on CT with functional assessment and conventional angiography ("Angio first" algorithm group) at screening [ Time Frame: Nov 2017 ]
  4. Inter-rater agreement on revascularization strategy (based on conventional angiography and CT with functional assessment) of two Heart Teams using an "Angio-first" algorithm or a "CT-first" algorithm at screening [ Time Frame: Nov 2017 ]
  5. Anatomical SYNTAX Score calculation based on non-invasive GE Revolution CT (visual by Heart Team involving an experienced coronary CT reader) and the resulting SYNTAX Score II at screening [ Time Frame: Nov 2017 ]
  6. Anatomical SYNTAX Score calculation based on non-invasive GE Revolution CT (visual by Core Lab) and the resulting SYNTAX Score II at screening [ Time Frame: Nov 2017 ]
  7. Anatomical SYNTAX Score calculation based invasive Angiography (visual by Heart Team) and the resulting SYNTAX Score II at screening [ Time Frame: Nov 2017 ]
  8. Anatomical SYNTAX Score calculation based on invasive Angiography (visual by Core Lab) and the resulting SYNTAX Score II at screening [ Time Frame: Nov 2017 ]
  9. CT based functional anatomy (FFRCT as assessed by Heartflow) at screening [ Time Frame: Nov 2017 ]
  10. Concordance in SYNTAX Score(s) between and within strategies at screening [ Time Frame: Nov 2017 ]
  11. Agreement in coronary stenosis segments to be revascularized between and within strategies at screening [ Time Frame: Nov 2017 ]

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population
Patients with complex coronary artery disease, defined as: left main (isolated, or associated with 1, 2 or 3 vessel disease) or de novo 3-vessel coronary artery disease (DS ≥50%), who are able to undergo cardiac CT with a GE high-definition RevolutionTM multi-slice CT scanner.

Inclusion Criteria:

  1. Patients with at least 1 stenosis (angiographic, visually determined de novo lesions with ≥50% DS) in all 3 major epicardial territories (LAD and/or side branch, CX and/or side branch, RCA and/or side branch) supplying viable myocardium with or without left main involvement;
  2. Patients with hypoplastic RCA with absence of descending posterior and presence of a lesion in the LAD and CX territories may be included in the trial as a 3VD equivalent;
  3. Vessel size should be at least 1.5 mm in diameter as visually assessed in diagnostic angiogram;
  4. Patients with chronic stable angina or stabilized acute coronary syndrome (inclusion criteria of the SYNTAX I study):

    • stable (Canadian Cardiovascular Society Class 1, 2, 3 or 4) angina pectoris;
    • or unstable (Braunwald class IB, IC, IIB, IIC, IIIB, IIIC) angina pectoris and ischemia with normal cardiac enzyme values prior to enrollment;
    • or patients with atypical chest pain or those who are asymptomatic provided they have myocardial ischemia (e.g. treadmill exercise test, radionuclide scintigraphy, stress echocardiography);
  5. All anatomical SYNTAX Scores are eligible;
  6. Patient amenable to a MSCT coronary angiography (e.g. no claustrophobia, high heartrate not amenable to beta-blockers, poor renal function, etc., up to discretion of investigator);
  7. Patient has been informed of the nature of the study and agrees to its provisions and has provided written informed consent as approved by the Ethical Committee of the respective clinical site;

Exclusion Criteria:

  1. Under the age of 18 years;
  2. Unable to give Informed Consent;
  3. Known pregnancy at time of enrolment. Female of childbearing potential (and last menstruation within the last 12 months), who are not taking adequate contraceptives. Female who is breastfeeding at time of enrolment;
  4. Prior PCI or CABG; history of coronary stent implantation;
  5. Evidence of evolving or ongoing acute myocardial infarction (AMI) in ECG and/or elevated cardiac biomarkers (according to local standard hospital practice) have not returned within normal limits at the time of enrollment;
  6. Concomitant cardiac valve disease requiring surgical therapy (reconstruction or replacement);
  7. Single or two-vessel disease (at time of Heart Team consensus);
  8. Atrial fibrillation or significant arrhythmias;
  9. Known allergy to iodinated contrast;
  10. A Body Mass Index (BMI) of 35 or greater;
  11. Participation in another trial with an investigational drug or device.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT02813473

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Brussel, Belgium
Nancy, France
Paris, France
Milan, Italy
Zurich, Switzerland
Sponsors and Collaborators
GE Healthcare
HeartFlow, Inc.
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Principal Investigator: Patrick W Serruys, Prof. Imperial College, London (UK)

Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: ECRI bv Identifier: NCT02813473     History of Changes
Other Study ID Numbers: ECRI-004
First Posted: June 27, 2016    Key Record Dates
Last Update Posted: December 10, 2018
Last Verified: December 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description:

The research data will be entered on separate forms and stored under a code number, according to prevailing legal requirements. No names or other personal data will be stored. Only the study doctor will hold the information to link the code to the patients. The encoded data will be processed, analysed and reported by the research employees of this study, who have an obligation of secrecy.

Representatives of the sponsor or members of the Ethics Committee (EC) and regulatory authorities within Europe can have access to the medical files in order to inspect the correctness of the research data. Data may be provided to representatives and affiliates of the industries supporting the study: General Electric and HeartFlow Inc. It is possible that the results of this study are presented or published in medical journals; this will always be without mention of the identity of the patients.

Keywords provided by ECRI bv:
Multi Slice Computed Tomography
Heart Team
Fractional Flow Reserve Computed Tomography
Percutaneous Coronary Intervention
Coronary Artery Bypass Graft
Additional relevant MeSH terms:
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Coronary Artery Disease
Myocardial Ischemia
Coronary Disease
Heart Diseases
Cardiovascular Diseases
Arterial Occlusive Diseases
Vascular Diseases