Coronary angiographic scoring systems: An evaluation of their equivalence and validity

doi:10.1016/j.ahj.2012.07.007

American Heart Journal

Volume 164, Issue 4, October 2012, Pages 547-552.e1

https://doi.org/10.1016/j.ahj.2012.07.007 Get rights and content

Background

Multiple scoring systems have been devised to quantify angiographic coronary artery disease (CAD) burden, but it is unclear how these scores relate to each other and which scores are most accurate. The aim of this study was to compare coronary angiographic scoring systems (1) with each other and (2) with intravascular ultrasound (IVUS)–derived plaque burden in a population undergoing angiographic evaluation for CAD.

Methods

Coronary angiographic data from 3600 patients were scored using 10 commonly used angiographic scoring systems and interscore correlations were calculated. In a subset of 50 patients, plaque burden and plaque area in the left anterior descending coronary artery were quantified using IVUS and correlated with angiographic scores.

Results

All angiographic scores correlated with each other (range for Spearman coefficient [ρ] 0.79-0.98, P < .0001); the 2 most widely used scores, Gensini and CASS-70, had a ρ = 0.90 (P < .0001). All scores correlated significantly with average plaque burden and plaque area by IVUS (range ρ 0.56-0.78, P < .0001 and 0.43-0.62, P < .01, respectively). The CASS-50 score had the strongest correlation (ρ 0.78 and 0.62, P < .0001) and the Duke Jeopardy score the weakest correlation (ρ 0.56 and 0.43, P < .01) with plaque burden and area, respectively.

Conclusions

Angiographic scoring systems are strongly correlated with each other and with atherosclerotic plaque burden. Scoring systems therefore appear to be a valid estimate of CAD plaque burden.

Section snippets

Study population

Analysis was performed in 3600 consecutive patients enrolled in the Emory Cardiology Biobank before undergoing elective or emergent cardiac catheterization across 3 Emory Healthcare sites, between 2003 and 2009. Patients were interviewed to collect information on demographic characteristics, medical history, and behavioral habits. Risk factor prevalence was determined by physician diagnosis and/or treatment for associated medical conditions such as hypertension, dyslipidemia, and diabetes

Results

A total of 3600 consecutive patients with complete angiographic data were included in the analysis. The cohort consisted of 66% males, median age 63 (interquartile range 55-71) years, the majority of whom were white (79.7%) (Table II). The prevalence of traditional risk factors was high and 62% of patients had prior percutaneous coronary intervention or coronary artery bypass grafting.

Discussion

In a large registry of patients carefully phenotyped for angiographic CAD, we demonstrate that commonly used angiographic scoring systems are (1) strongly correlated with each other and (2) strongly correlated with IVUS-derived measures of atherosclerotic plaque burden in the LAD artery, even in the absence of significant luminal stenosis.

Since the advent of coronary angiography, multiple scoring systems have been devised for the quantification of CAD burden. Although previous studies have

Disclosures

Dr. Samady reports a research grant by Volcano Corporation.

Acknowledgements

We would like to thank the attendings and fellows from the Cardiology Division of Emory University as well as the cardiac catheterization laboratory staff for their continued support and assistance in recruiting patients for the Emory Cardiology Biobank.

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^f: These authors contributed equally to this work.

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Clinical InvestigationInterventional CardiologyCoronary angiographic scoring systems: An evaluation of their equivalence and validity

Background

Methods

Results

Conclusions

Section snippets

Study population

Results

Discussion

Disclosures

Acknowledgements

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Am J Cardiol

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J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

Am Heart J

Am J Cardiol

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J Am Coll Cardiol

J Am Coll Cardiol

Am Heart J

Int J Cardiol

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Heart disease and stroke statistics—2011 update: a report from the American Heart Association

Circulation

Clinical Investigation
Interventional Cardiology
Coronary angiographic scoring systems: An evaluation of their equivalence and validity