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

• Type of Material: Article
• Authors: Ian J. Neeland, University of Texas Southwestern; Riyaz S. Patel, Emory University; Parham Eshtehardi, Emory University; Saurabh Dhawan, Emory University; Michael C McDaniel, Emory University; Syed Tanveer Rab, Emory University; Viola Vaccarino, Emory University; A. Maziar Zafari, Emory University; Habib Samady, Emory University; Arshed Ali Quyyumi, Emory University
• Language: English
• Date: 2012-10
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 Mosby, Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ahj.2012.07.007
• Title of Journal or Parent Work: American Heart Journal
• ISSN: 0002-8703
• Volume: 164
• Issue: 4
• Start Page: 547
• End Page: 552.e1
• Grant/Funding Information: This work was supported by the Robert W. Woodruff Health Sciences Center Fund and the Emory Heart and Vascular Center Fund (both in Atlanta, GA) and supported in part by NIH Grant UL1 RR025008 from the Clinical and Translational Science Award program and NIH R01HL089650-02.
• Keywords: Intravascular Ultrasound; Atherosclerosis; Coronary Disease; Angiography; Scoring Systems
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

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 was scored using 10 commonly used angiographic scoring systems and inter-score correlations were calculated. In a subset of 50 patients, plaque burden and plaque area in the left anterior descending coronary artery was 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<0.0001); the two most widely used scores, Gensini and CASS-70, had a ρ = 0.90, p<0.0001. All scores correlated significantly with average plaque burden and plaque area by IVUS (range ρ: 0.56-0.78, p<0.0001 and 0.43-0.62, p<0.01, respectively). The CASS-50 score had the strongest correlation (ρ: 0.78 and 0.62, p<0.0001) and the Duke Jeopardy score the weakest correlation (ρ: 0.56 and 0.43, p<0.01) 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.