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Author Notes:

Correspondence: Arshed A. Quyyumi, MD, Emory University School of Medicine, 1462 Clifton Road, Suite 506, Atlanta, GA 30322; Fax: 404-712-0419; Tel: 404-712-2741; Email: aquyyum@emory.edu

Authors' Contributions: The first two authors contributed equally to this work.

Acknowledgments: 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.

Disclosures: Dr. Samady reports a research grant by Volcano Corporation.


Research Funding:

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.


  • Atherosclerosis
  • Angiography
  • Coronary Disease
  • Intravascular Ultrasound
  • Scoring Systems

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


Journal Title:

American Heart Journal


Volume 164, Number 4


, Pages 547-552.e1

Type of Work:

Article | Post-print: After Peer Review


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.

Copyright information:

© 2012 Mosby, Inc. All rights reserved.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported License (http://creativecommons.org/licenses/by-nc-nd/3.0/).

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