Coronary Angiographic Scoring Systems

An Evaluation of Their Equivalence and Validity

Ian J. Neeland, MD; Riyaz S. Patel, MD; Parham Eshtehardi, MD; Saurabh Dhawan, MD; Michael C. McDaniel, MD; S. Tanveer Rab, MD; Viola Vaccarino, MD, PhD; A. Maziar Zafari, MD, PhD; Habib Samady, MD; Arshed A. Quyyumi, MD


Am Heart J. 2012;164(4):547-552.e1. 

In This Article


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.

Angiographic Scoring Systems and Interscore Correlations

Ten scoring systems were included in the final analysis: CASS-50,[2] CASS-70,[2] Gensini,[3] Duke Jeopardy,[19,20] Duke CAD Severity Index,[21] Friesinger,[22,23] Sullivan Vessel, Sullivan Stenosis, Sullivan Extent,[24] and Jenkins[25] scores (Table III). Correlation analysis demonstrated that scoring systems were highly linearly correlated with each other (range for ρ 0.79–0.98, P < .0001 for all correlations) (Table IV). The 2 most widely used scores in the literature, Gensini and CASS-70, had a correlation of ρ = 0.90 (P < .0001) (Figure 1).

Figure 1.

Distribution of Gensini scores with CASS-70 scores (ρ = 0.90, P < .0001).

Angiographic Scores and IVUS

Angiographic scoring systems were all highly correlated with atherosclerotic plaque burden (range for ρ 0.56–0.78, P < .0001 for all correlations) and moderately correlated with plaque area (range for ρ 0.43–0.62, P < .01 for all correlations) (Table V). The CASS-50 score had the strongest correlation with both plaque burden and plaque area (ρ 0.78 and 0.62, P < .0001) (Figure 2) and the highest correlation with all IVUS parameters in a multiple linear regression model (Spearman's multiple rho rank correlation 0.76, P < .0001) (Table V ). The Duke Jeopardy score had the weakest correlation with both parameters (ρ 0.56 and 0.43, P < .01).

Figure 2.

Distribution of average percent plaque burden with CASS-50 scores (ρ = 0.78, P < .0001).