Gensini Score for Determining the Severity of Coronary Artery Disease

Procedure:

(1) Angiography is performed on both the left and right coronary arteries, and each segment is examined.

(2) A score is assigned based on the degree of luminal obstruction, which may involve either concentric or eccentric lesions

(3) Points are assigned starting at 25% occlusion, with values doubled for each increasing level of occlusion. The point assignment is based on the angiographic estimate of percent occlusion and as such is not overly precise.

(4) The score for each segment is then multiplied by a weighting factor, which reflects the relative importance of that particular coronary segment.

Figure 1, page 606, Gensini, 1983

where:

• The posterior descending artery determines the blood supply to the inferior portion of the left ventricle. 70% of the time it arises from the right coronary artery (right coronary artery dominant), 10% from the left circumflex artery (left coronary artery dominant), and 20% from both right and left coronary arteries (shared dominance).

score =

= SUM((points for each segment) * (weighting factor))

Interpretation:

• minimum score: 0

• maximum score: theoretically 656 (assumes complete obstruction of all the coronary artery segments)