Ming-Xing Xu1, Ruo-Ling Teng1, Terrence D Ruddy2, Paul Schoenhagen3, Thomas Bartel4, Roberto Di Bartolomeo5, Olcay Aksoy6, Milind Desai7, Yskert von Kodolitsch8, Javier Escaned9, Peter A McCullough10, Anupama Vasudevan10, Cheng-Xing Shen11, Xin Zhao1, Ya-Feng Zhou1, Hai-Feng Xu1, Xu-Jie Cheng1, Yong-Ming He1. 1. Division of Cardiology, First Affiliated Hospital of Soochow University, Suzhou 215006, China. 2. Division of Cardiology, Heart Institute, University of Ottawa, Ottawa, Canada. 3. Imaging Institute, Cleveland Clinic, Cleveland, OH, USA. 4. Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE. 5. Cardio-Thoracic and Vascular Department, Division of Cardiac Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy. 6. Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. 7. Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA. 8. Department of Cardiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 9. Department of Cardiology, Hospital San Carlos, Madrid, Spain. 10. Division of Cardiology, Heart & Vascular Institute, Baylor University Medical Center, Dallas, TX, USA. 11. Department of Cardiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200233, China.
Abstract
BACKGROUND: The SYNTAX score for decision makings or outcome predictions in coronary artery disease does not account for the variations in the coronary anatomy, which is a clear fallacy for patients with less typical anatomy than suggested by the SYNTAX score. The current study aimed to derive a new coronary angiographic scoring system accommodating the variability in the coronary anatomy. METHODS: The 17-myocardial segment model and laws of competitive blood supply and flow conservation were utilized to derive this new scoring system. RESULTS: We obtained 6 types of RCA dominance, 3 types of diagonal size and 3 types of left anterior descending artery (LAD) length, which together resulted in a total of 54 patterns of coronary artery circulation to account for the variability in the coronary anatomy among individuals. A Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system has been designed based on the above-mentioned reclassification scheme (htpp://www.catletscore.com, IE browser is required to run this calculator). CONCLUSIONS: This new CatLet angiographic scoring system accommodated the variability in the coronary anatomy and standardized the collection of the coronary angiographic data, which could facilitate the comparison and exchange of these data between different catheter labs. Its utility for predicting the clinical outcomes and standardizing the angiographic data collection will be investigated in a series of clinical trials enrolling "all-comers" with coronary artery disease (CAD). 2019 Journal of Thoracic Disease. All rights reserved.
BACKGROUND: The SYNTAX score for decision makings or outcome predictions in coronary artery disease does not account for the variations in the coronary anatomy, which is a clear fallacy for patients with less typical anatomy than suggested by the SYNTAX score. The current study aimed to derive a new coronary angiographic scoring system accommodating the variability in the coronary anatomy. METHODS: The 17-myocardial segment model and laws of competitive blood supply and flow conservation were utilized to derive this new scoring system. RESULTS: We obtained 6 types of RCA dominance, 3 types of diagonal size and 3 types of left anterior descending artery (LAD) length, which together resulted in a total of 54 patterns of coronary artery circulation to account for the variability in the coronary anatomy among individuals. A Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system has been designed based on the above-mentioned reclassification scheme (htpp://www.catletscore.com, IE browser is required to run this calculator). CONCLUSIONS: This new CatLet angiographic scoring system accommodated the variability in the coronary anatomy and standardized the collection of the coronary angiographic data, which could facilitate the comparison and exchange of these data between different catheter labs. Its utility for predicting the clinical outcomes and standardizing the angiographic data collection will be investigated in a series of clinical trials enrolling "all-comers" with coronary artery disease (CAD). 2019 Journal of Thoracic Disease. All rights reserved.
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