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

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.