A new proposed comprehensive expanded coronary artery lesion description code system and coronary artery angiographic segmental classification – A mathematical model: Indian society of cardiology working group code for physician’s ease

Abstract: BACKGROUND: A simplified coronary artery angiographic segmental (CAAS) classification relevant to interventional cardiologists and cardiac surgeons to explain and plan exact anatomical site for stent or graft implantation and to assess pre-procedural amount of myocardium at ischemic risk has been proposed. Comprehensive Coronary Artery Lesion Description (CALD) code system has been developed to overcome the limitations of anatomical variations in coronary arteries to tell the exact location of lesion and its anatomical characteristics, hence preparing a mathematical model to express coronary artery lesion, unaffected by anatomical variation for physician ease. METHODS: This is a single centre, retrospective, observational study. 100 patients were undertaken to understand and validate CALD code system and CAAS classification. RESULTS: CALD code system has 9 positions in sequence to depict various characteristics of coronary artery lesion as a code. Position 1-vessel involved, Position 2-vessel segment-I (first 40 mm), II (second 40mm), III (remaining segment), Position 3-lesion quantification, Position 4-lesion length, Position 5-side branchesdescription, Position 6-other features ‘JECTODS-Z (‘JCTO’ in basic classification) depicting Junctional location, Ectasia, Calcification, Thrombus and tOrtuosity, Dissection, Stent description and Z for none of the above features respectively, Position 7-TIMI (Thrombolysis In Myocardial Infarction) flow, Position 8-MBG (Myocardial blush grade), Position 9-dominant vessel. For Left main artery lesion description and vessel characteristics, these are depicted by a code in sequence of four in place of nine used for LAD, LCX and RCA vessels. it has four position in sequence to depict vessel and lesion characteristics. This is Position 1-vessel involved, Position 2-vessel segment, Position 3-lesion quantification, Position 4 other features ‘CT DS-Z (Calcification, Thrombus, Dissection, Stent description and Z for none of the above features) respectively. CONCLUSIONS: This is a simple, semi-quantitative and easy to memorize description of the coronary artery lesions in terms of mathematical model of coronary arteries for reproducibility and for ease of physicians with hemodynamic parameters in live mode.