The CatLet score: a new coronary angiographic scoring tool accommodating the variable coronary anatomy for the first time

Xu, Min; Teng, Ruo-Ling; Ruddy, Terrence D.; Schoenhagen, Paul; Bartel, Thomas; Bartolomeo, Roberto Di; Aksoy, Olcay; Desai, Milind Y.; Kodolitsch, Yskert Von; Escaned, Javier; McCullough, Peter A.; Vasudevan, Anupama; Shen, Chengxing; Zhao, Xin; Zhou, Yafeng; Xu, Haifeng; Cheng, Xiaoguang; He, Yao

doi:10.21037/jtd.2019.12.18

Cited by 10 publications

(43 citation statements)

References 13 publications

(7 reference statements)

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“…Our CatLet score reflecting the variability in coronary anatomy performed well in terms of risk stratification between the lower two tertiles. Derivation of the CatLet score is based on our weighted matrix, 3 where the weighting factor assignment for coronary artery trees was based on the arterial importance. By contrast, the SYNTAX score was based on the Leaman score, 6 where the weighting factor assignment was largely based on the arterial nomenclature, failing to reflect the variability in coronary anatomy.…”

Section: Discussionmentioning

confidence: 99%

“…Average RCA was judged according to the presence of a significant branch arising from the LCX. 3 The lesion is amplified in the upper right area of Figure 1c. Adverse nonstenotic characteristics pertinent to the lesion were not scored and instead qualitatively recorded as "Yes" or "No."…”

Section: Patientsmentioning

confidence: 96%

“…The CatLet angiographic scoring system has been described elsewhere in detail. 3 In short, it is a comprehensive angiographic scoring system, where the variability in the coronary anatomy is fully accounted for, only a stenosis lesion is scored and further modified if appropriate, and the adverse characteristics pertinent to the lesion are not scored, but only qualitatively recorded. 3 The lesion score is a product of the weighting factor of the blood vessel and its degree of stenosis.…”

Section: The Catlet Score and The Lesion Evaluationmentioning

confidence: 99%

“…The coronary artery tree description and lesion evaluation (CatLet) score, which can account for the variable coronary anatomy, is a recently developed and comprehensive angiographic scoring system aimed at assisting in the risk-stratification of CAD patients. 3 However, a validation of this angiographic scoring system is still lacking.…”

Section: Introductionmentioning

confidence: 99%

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The CatLet score and outcome prediction in acute myocardial infarction for patients undergoing primary percutaneous intervention: A proof‐of‐concept study

Ruddy

Schoenhagen

et al. 2020

Cathet Cardio Intervent

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Background The Coronary Artery Tree description and Lesion EvaluaTion (CatLet) score accommodating the variability in coronary anatomy is a recently developed and comprehensive angiographic scoring system aimed at assisting in risk‐stratification of patients with coronary artery disease. However, a validation of this angiographic scoring system is lacking. Methods The CatLet score was calculated retrospectively in 308 consecutively enrolled patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention. The primary endpoint, major adverse cardiac or cerebrovascular events (MACCEs), was stratified according to CatLet tertiles: CatLetlow ≤14 (n = 124), CatLetmid 15–21 (n = 82) and CatLettop ≥22 (n = 102). Results The CatLet score alone or after adjusting for a broad spectrum of risk factors, significantly predicted clinical outcomes at a median 4.3‐year follow‐up. Multivariable‐adjusted hazard ratios (95%CI)/unit higher score were 1.05 (1.04–1.07) for MACCE, 1.06 (1.04–1.07) for cardiac death, and 1.05 (1.04–1.07) for all‐cause death. When compared to the SYNTAX score, improved discrimination and better calibration of this CatLet score resulted in a significantly refined risk stratification. The overall category‐free net reclassification improvement afforded by this CatLet score was as follows: 37.2% (p = .008) for MACCEs, 35.5% (p = .0249) for cardiac death, and 31.8% (p = .0316) for all‐cause death. Conclusions The ability to integrate the variability in coronary anatomy into angiographic scoring makes the CatLet score a more specific tool for outcome predictions in AMI. (http://http://www.chictr.org.cn. Unique identifiers: ChiCTR‐POC‐17013536).

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Section: Discussionmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 96%

Section: The Catlet Score and The Lesion Evaluationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The CatLet score and outcome prediction in acute myocardial infarction for patients undergoing primary percutaneous intervention: A proof‐of‐concept study

Ruddy

Schoenhagen

et al. 2020

Cathet Cardio Intervent

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“…Recently, we have developed a novel C oronary A rtery T ree description and L esion E valua T ion (CatLet © ) angiographic scoring system, which is capable to account for the variability in the coronary anatomy and to assist in risk-stratification of patients with acute myocardial infarction (AMI) and collection of angiographic data. [ 1 , 2 ] According to this new score's algorithm, only a lesion ≥50% diameter stenosis in vessels >1.5 mm in diameter is scored and further modified if appropriate, and the adverse characteristics pertinent to the lesion are not scored anymore, but only qualitatively recorded instead. [ 2 ] The Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score, another angiographic scoring tool, has been widely used to grade the severity and complexity of coronary artery disease (CAD) and to predict clinical outcomes for CAD patients.…”

Section: Introductionmentioning

confidence: 99%

Inter- and intra-observer variability for the assessment of coronary artery tree description and lesion EvaluaTion (CatLet©) angiographic scoring system in patients with acute myocardial infarction

Liu

Teng

Qian

et al. 2020

Chinese Medical Journal

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Background: Previously, we developed a novel C oronary A rtery T ree description and L esion E valua T ion (CatLet © ) angiographic scoring system, which was capable of accounting for the variability in the coronary anatomy and assisting in the risk-stratification of patients with acute myocardial infarction (AMI). Our preliminary study revealed that the CatLet score better predicted clinical outcomes for AMI patients than the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score. However, the reproducibility of the CatLet score in both inter- and intra-observer remains to be evaluated. Methods: A total of 30 consecutive AMI patients, admitted in September of 2015, were independently assessed by two experienced interventional cardiologists to evaluate the inter-observer reproducibility of the CatLet score. Another set of 49 consecutive AMI patients, admitted between September and October in 2014, were assessed by one of the two interventional cardiologists on two occasions 3 months apart to evaluate the intra-observer reproducibility of the CatLet score. The weighted kappa was used to express the degree of agreement. Results: The weighted kappa values (95% confidence interval) for the intra- and inter-observer reproducibility of the CatLet Score were 0.82 (0.59–1.00, Z = 7.23, P < 0.001) and 0.86 (0.54–1.00, Z = 5.20, P < 0.001), respectively, according to the tertile analysis (≤14, 15–22, >22). Regarding the adverse characteristics pertinent to lesions and dominance parameters, the kappa values for the inter-observer variability were 0.80 (0.56–1.00, Z = 6.47, P < 0.001) for total number of lesions, 0.57 (0.28–0.85, Z = 3.03, P < 0.001) for bifurcation, 0.69 (0.43–0.96, Z = 5.06, P < 0.001) for heavy calcification, 1.00 (0.72–1.00, Z = 6.93, P < 0.001) for tortuosity, 0.54 (0.26–0.82, Z = 3.78, P < 0.001) for thrombus, 0.69 (0.48–0.91, Z = 6.29, P < 0.001) for right coronary artery dominance, 0.69 (0.41–0.96, Z = 4.91, P < 0.001) for left anterior descending artery length, and 0.22 (0.06–0.51, Z = 1.56, P = 0.06) for diagonal size. Equivalent values for the intra-observer variability were moderate to almost perfect (range...

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CatLet score and clinical CatLet score as predictors of long-term outcomes in patients with acute myocardial infarction presenting later than 12 hours from symptom onset

He,

Masuda,

Jiang

et al. 2024

Annals of Medicine

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Background Our recently developed C oronary A rtery T ree description and L esion E valua T ion (CatLet) angiographic scoring system is unique in its description of the variability in the coronary anatomy, the degree of stenosis of a diseased coronary artery, and its subtended myocardial territory, and can be utilized to predict clinical outcomes for patients with acute myocardial infarction (AMI) presenting ≤12 h after symptom onset. The current study aimed to assess whether the Clinical CatLet score (CCS), as compared with CatLet score (CS), better predicted clinical outcomes for AMI patients presenting >12 h after symptom onset. Methods CS was calculated in 1018 consecutive AMI patients enrolled in a retrospective registry. CCS was calculated by multiplying CS by the ACEF I score (age, creatinine, and left ventricular ejection fraction). Primary endpoint was major adverse cardiac events (MACEs) at 4-year-follow-up, a composite of cardiac death, myocardial infarction, and ischemia-driven revascularization. Results Over a 4-year follow-up period, both scores were independent predictors of clinical outcomes after adjustment for a broad spectrum of risk factors. Areas-under-the-curve (AUCs) for CS and CCS were 0.72(0.68–0.75) and 0.75(0.71–0.78) for MACEs; 0.68(0.63–0.73) and 0.78(0.74–0.83) for all-cause death; 0.73(0.68–0.79) and 0.83(0.79–0.88) for cardiac death; and 0.69(0.64–0.73) and 0.75(0.7–0.79) for myocardial infarction; and 0.66(0.61–0.7) and 0.63(0.58–0.68) for revascularization, respectively. CCS performed better than CS in terms of the above-mentioned outcome predictions, as confirmed by the net reclassification and integrated discrimination indices. Conclusions CCS was better than CS to be able to risk-stratify long-term outcomes in AMI patients presenting >12 h after symptom onset. These findings have indicated that both anatomic and clinical variables should be considered in decision-making on management of patients with AMI presenting later.

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The CatLet score: a new coronary angiographic scoring tool accommodating the variable coronary anatomy for the first time

Cited by 10 publications

References 13 publications

The CatLet score and outcome prediction in acute myocardial infarction for patients undergoing primary percutaneous intervention: A proof‐of‐concept study

The CatLet score and outcome prediction in acute myocardial infarction for patients undergoing primary percutaneous intervention: A proof‐of‐concept study

Inter- and intra-observer variability for the assessment of coronary artery tree description and lesion EvaluaTion (CatLet©) angiographic scoring system in patients with acute myocardial infarction

CatLet score and clinical CatLet score as predictors of long-term outcomes in patients with acute myocardial infarction presenting later than 12 hours from symptom onset

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