Establishing a Coronary Angiography Jeopardy Score for Myocardial Risk Assessment: A Comparison with the Duke Treadmill Score

Abstract

Exercise tolerance test (ETT) is a low cost and readily available stress test to investigate for ischemic heart disease (IHD) in low-moderate risk population [1]. Different scoring systems have been developed on the basis patient history, gender and symptoms etc., to predict risk IHD risk. The most widely used scoring system is Duke Treadmill Score (DTS), which categorizes the patients in three different groups with low, moderate and high risk for IHD [2]. Due to moderate specificity and sensitivity of ETT, the treadmill test is combined with other imaging modalities and invasive testing to predict the severity of IHD and long-term prognosis, like; Callif Scoring [2], Coronary artery Surgery Study (CASS) [3], Gensini score [4] and SYNTEX II scoring system [5]. Majeed A. A. Al-Labban in his research work [6], has developed Coronary Angiography Jeopardy Score (CAJS), to look into severity of plaque burden and its prognostic implication, in patients with Chronic Coronary Disease (CCD) with moderate-high DTS. The three main components of his score are; Number of coronary vessels involved Severity of Coronary artery stenosis Left Ventricular Systolic function by calculating Ejection Fraction. The maximum score is 12. There are three groups on the basis of three different scores; CAJS ≥ 8 CAJS ≥ 4 but <8 CAJS ≥ 2 but <4 Unlike other available scoring systems, the author has included Segmental Wall Motion Abnormalities (SWMA) and Left Ventricular systolic functions as surrogate markers for the jeopardized myocardium of the stenosed coronary artery as well, which further adds value to his work. The author has not included any parameter for gender, which may be a plus point that makes calculating CAJS simpler, but the cardio vascular (CV) literature shows different outcomes of stress tests, among male and female gender. This lack of clarity on female gender inclusion may need further evaluation of CAJS and validation. In developed word, the noninvasive testing is shifting more towards Coronary CT Angiography (CCTA). CCTA has excellent negative predictive value in the population who are at moderate risk of IHD, and CCTA moderately correlates well with the severity of coronary artery disease [7], as shown by British Cardio Vascular Intervention Society Jeopardy Score (BCIS-JS) [8,9]. Another point is the long term results of this score, which will lead to its validation. We have to wait for long time to implement this score and calculate its percept mortality for next 05years, 10 years and beyond. The development of a new score as CAJS is a valuable work and adds to the cardiovascular literature in terms of predicting severity of CAD and its longterm prognosis, especially the score has taken in account the jeopardised myocardium of the stenosed coronary artery. References Mark DB, Shaw L, Harrell Jr FE, Hlatky MA, Lee KL, Bengtson JR, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med. 1991;325(12):849-53. DOI: 10.1056/nejm199109193251204 Califf RM, Phillips HR 3rd, Hindman MC, Mark DB, Lee KL, Behar VS, et al. Prognostic value of a coronary artery jeopardy score. J Am Coll Cardiol. 1985;5(5):1055-63. DOI: 10.1016/s0735-1097(85)80005-x Ringqvist I, Fisher LD, Mock MI, Davis KB, Wedel HA, Chaitman BR, et al. Prognostic value of angiographic indices of coronary artery disease from the Coronary Artery Surgery Study (CASS). J Clin Invest. 1983;71(6):1854-66. 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