title: Assessment and validation of a novel angiographic scoring system for peripheral artery disease.
abstract: BACKGROUND
  Angiography is used routinely in the assessment of lower-limb arteries, but there are few well validated angiographic scoring systems. The aim of this study was to develop and validate a novel angiographic scoring system for peripheral artery disease.
  
  
  METHODS
  An angiographic scoring system (the ANGIO score) was developed and applied to a sample of patients from a single vascular surgical department who underwent CT angiography of the lower limbs. The reproducibility of the ANGIO score was compared with those of the Bollinger and Trans-Atlantic inter-Society Consensus (TASC) IIb systems in a series of randomly selected patients. Associations between the ANGIO score and lower-limb ischaemia, as measured by the ankle : brachial pressure index (ABPI), and outcome events (major lower-limb amputations and cardiovascular events - myocardial infarction, stroke and cardiovascular death) were assessed.
  
  
  RESULTS
  Some 256 patients undergoing CT angiography were included. The interobserver reproducibility of the ANGIO score was better than that of the other scoring systems examined (κ = 0·90, P = 0·002). There was a negative correlation between the ANGIO score and ABPI (ρ = -0·33, P = 0·008). A higher ANGIO score was associated with an increased risk of major lower-limb amputation (hazard ratio (HR) for highest versus lowest tertile 9·30, 95 per cent c.i. 1·95 to 44·38; P = 0·005) and cardiovascular events (HR 2·73, 1·31 to 5·70; P = 0·007) following adjustment for established risk factors.
  
  
  CONCLUSIONS
  The ANGIO score provided a reproducible and valid assessment of the severity of lower-limb ischaemia and risk of major amputation and cardiovascular events in these patients with peripheral artery disease.
authors.affiliation: Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Queensland, Australia.
authors.forename: D R
authors.initials: DR
authors.lastname: Morris
authors.affiliation: Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Queensland, Australia.
authors.forename: T P
authors.initials: TP
authors.lastname: Singh
authors.affiliation: Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Queensland, Australia.
authors.forename: J V
authors.initials: JV
authors.lastname: Moxon
authors.affiliation: Department of Anatomy, School of Rural Medicine, University of New England, Armidale, New South Wales, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Smith
authors.affiliation: Department of Anatomy, School of Rural Medicine, University of New England, Armidale, New South Wales, Australia.
authors.forename: F
authors.initials: F
authors.lastname: Stewart
authors.affiliation: Division of Tropical Health and Medicine, James Cook University, Queensland, Australia.
authors.forename: R E
authors.initials: RE
authors.lastname: Jones
authors.affiliation: Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, Queensland, Australia.|Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Queensland, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Golledge
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D001158:Arteries / Q000000981:diagnostic imaging*; D000072226:Computed Tomography Angiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging* / Q000601:surgery; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D014656:Vascular Surgical Procedures