gensini評分標準

1、POINT OF VIEW A More Meaningful Scoring System for Determining the Severity of Coronary Heart Disease GOFFREDO G. GENSINI, MD Selzer ~ in a recent editorial criticized the classification of the severity of coronary

2、 artery disease (CAD) which is currently used in all randomized trials on the surgical versus medical therapy of CAD. He pointed out that the classification of single-, double-, triple-vessel and main left (SDTML) cor

3、o- nary artery disease allows the inclusion in each subgroup of a mixture of patients with both a favorable and an unfavorable prognosis and provides, at best, only marginal differentiation of medically and surgicall

4、y treated patients. He further sug- gested that patients with CAD should be identified on the basis of severity of narrowings, cardiac performance, effec- tiveness of coronary collateral circulation, amount of myo- c

5、ardium jeopardized by ischemia, and possibly other factors as well. I wholeheartedly share these views, as described in my book in 1975. 2 An updated version of this scoring and stratifying method and a critique of the

6、 SDTML disease classification appeared in 1980. 3 There I stated: “A method that assigns a different severity score depending on the degree of luminal narrowing and the geographical importance of its location would b

7、e desirable .... Several years ago, recognizing these From Msgr. Toomey Cardiovascular Laboratory, St. Joseph's Hospital Health Center, Syracuse, New York. shortcomings, I devised a system that takes into considerat

8、ion the geometrically increasing severity of lesions, the cumulative effects of multiple obstructions, the significance of their lo- cations, the modifying influence of the collaterals, the size and quality of the di

9、stal vessels, and the importance of the status of myocardial function [Fig. 1] .... The fundamental concept forming the basis of this system is the hypothesis that the severity of coronary artery disease must be regar

10、ded as a consequence of the functional significance of the vascular narrowing and the extent of the area perfused by the involved vessel or vessels; the presence of an effective collateral situa- tion may, on the oth

11、er hand, modify the functional signifi- cance of a severe obstruction or occlusion .... Although this method may not be ideal, it provides more useful information than the simple division of patients into single-, dou

12、ble-, and triple-vessel disease. The advantages of this scoring method are as follows: (l) it provides an accurate stratification of pa- tients according to the functional significance of their disease; (2) it lends

13、itself to computer elaboration, storage, retrieval, and analysis; (3) it provides an opportunity to match patients with similar degrees of coronary artery disease who are re- ceiving different forms of treatment; and

14、(4) it allows for continuous, microprocessor-assisted studies of interobserved and intraobserver variability. Computer hardware and soft- ware to elaborate and store this type of information are readily available and

15、 are inexpensive.“ Thus, the challenge of Selzer had already been met several years ago by a classification of patients with CAD, but this classification has not been utilized by others. It is time for cardiologists to

16、 adopt a more meaningful measurement of the severity of CAD. References 1. Seizer A. On the limitation of therapeutic intervention trials in ischemtc heart disease: a clinician's viewpoint. Am J Cardiol 1982;49:252-

17、255. 2. Gensini GG. Coronary arteriography. Mt. Kisco, NY: Futura, 1975:488. 3. Gensini GG. Coronary arteriography. In: Heart Disease. Braunwald E, ed. Philadelphia: WB Saunders, 1980:352-353. Concentric les Eccentnc p

18、laque 25 50 75 90 >,99,99<, 100% m 1 2 4 8 16 32 Reduction of lumen diameter Seventy score i : x' t.. .“: Xl :,_,-:-~-~ Prox X 2 5 ,..,'~...[!i~“~..~ - :. (3 5) 7“,:;“ .“rf~.“ ““ “' “,“ ? ;(

19、 .: oM,, it,/~~xl', i X5 X25 ', MLCA, Prox ,.:, “,, : I°D '; .,'.':';..': ““ Xl ,',...: “ 200 :':t, : ~ i( 5 Prox -- proximal segment Mid m mtdsegment Dist -- dtstalsegm

20、ent PD~ postenor descending MLCA-- main left coronary artery l°D - first dtagonal 2 °D- second diagonal Aptc- aptcal OM m obtuse marginal PL -- posterolateral FIGURE 1. Left panel, roentgenographic app

21、earance of concentric lesions and eccentric plaques resulting in, respectively, 25, 50, 75, 90, and 99 % obstruction as well as complete occlusion (100 % ). The right column in this panel indicates the relative severity

22、 of these lesions using a score of 1 for 25 % obstruction and doubling that number as the severity of the obstructions progresses according to the indicated reduction of lumen diameter (left column). Right panel, the p

23、rincipal vascular segments of (from left to right) the right coronary artery, the left anterior descending, and the circumflex. Each segment is followed by a multiplying factor such as Xl, X2.5, and so on, depending on