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. 2024 Aug 13:20:359-368.
doi: 10.2147/VHRM.S431612. eCollection 2024.

Interobserver Variability of Coronary Stenosis Characterized by Coronary Angiography: A Single-Center (Toronto General Hospital) Retrospective Chart Review by Staff Cardiologists

Seyedmohammadshahab Shivaie  1 , Hadi Tohidi  1 , Pragash Loganathan  1 , Manish Kar  1 , Habiba Hashemy  1 , Mohammad A Shafiee  1
Affiliations

Interobserver Variability of Coronary Stenosis Characterized by Coronary Angiography: A Single-Center (Toronto General Hospital) Retrospective Chart Review by Staff Cardiologists

Seyedmohammadshahab Shivaie et al. Vasc Health Risk Manag. .

Abstract

Introduction: The reliability of interpretation of coronary angiography as a diagnostic tool was investigated. Furthermore, the impact of interobserver variability of coronary lesions on clinical decision-making was assessed. One of our motivations to do this research was the research gaps and our aim to have up-to-date information regarding interobserver variability among different cardiologists.

Methods: Our objective was to quantify interobserver variability among cardiologists who have seen angiograms independently. Disagreement among cardiologists in the visual assessment of invasive coronary angiography of coronary artery stenosis is not uncommon in previous studies. Three cardiologists with extensive experience in coronary angiography, including the primary cardiologist of each patient, read the angiograms of 200 patients from Toronto General Hospital independently.

Results: Our research showed the mean agreement among all participating observers was 77.4%; therefore, the interobserver variability of coronary angiography interpretation was 22.6%.

Discussion: Coronary angiography is still the gold-standard technique for guidance regarding coronary lesions. Sometimes, coronary angiography results in underestimation or overestimation of a lesion's functional severity. Interobserver variability should also be considered when interpreting the severity of coronary stenoses via invasive coronary angiography. This research shows that interobserver variability regarding coronary angiograms is still present (22.6%).

Keywords: ICA; PCI; coronary angiography; fractional flow reserve; interobserver variability.

Plain language summary

Plain language summary: The gold-standard method for diagnosing coronary stenosis, invasive coronary angiography has some challenges too. One of these challenges has been the difference among various cardiologists regarding determination of severity of each coronary stenosis. In this study, we focused on differences in interobserver variability in coronary angiography interpretation. Three cardiologists who were experienced in coronary angiography read each patient’s coronary angiogram separately. Overall, 200 patients with a history of angiography at Toronto General Hospital were selected randomly. The research showed that overall agreement among all participating cardiologists with regard to the reading of coronary angiograms was 77.4%. In other words, interobserver variability of 22.6% was seen among the readers.

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Conflict of interest statement

The authors report no conflicts of interests for this work.

Figures

Figure 1
Figure 1
Agreement (ICC) among the three observers’ reports.
Figure 2
Figure 2
Frequency of each specific percentage reported by participant cardiologists (total number of reported stenoses 660).
Figure 3
Figure 3
Top row, coronary angiogram; middle row, IVUS; bottom row, OCT of the same coronary lesion.
See this image and copyright information in PMC

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