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Effect of variability in the interpretation of coronary angiograms on the appropriateness of use of coronary revascularization procedures.

Abstract：

BACKGROUND:Evidence from numerous studies of coronary angiography show differences between observers' assessments of 15% to 45%. The implication of this variation is serious: If readings are erroneous, some patients will undergo revascularization procedures unnecessarily and others will be denied an essential treatment. We evaluated the variation in interpretation of angiograms and its potential effect on appropriateness of use of revascularization procedures. METHODS AND RESULTS:Angiograms of 308 randomly selected patients previously studied for appropriateness of angiography, coronary artery bypass grafting (CABG), and percutaneous transluminal coronary angioplasty (PTCA) were interpreted by a blinded panel of 3 experienced angiographers and compared with the original interpretations. The potential effect on differences on the appropriateness of revascularization was assessed by use of the RAND criteria. Technical deficiencies were found in 52% of cases. Panel readings tended to show less significant disease (none in 16% of vessels previously read as showing significant disease), less severity of stenosis (43% lower, 6% higher), and lower extent of disease (23% less, 6% more). The classification of CABG changed from necessary/appropriate to uncertain/inappropriate for 17% to 33% of cases when individual ratings were replaced by panel readings. CONCLUSIONS:The general level of technical quality of coronary angiography is unsatisfactory. Variation in the interpretation of angiograms was substantial in all measures and tended to be higher in individual than in panel readings. The effect was to lead to a potential overestimation of appropriateness of use of CABG by 17% and of PTCA by 10%. These findings indicate the need for increased attention to the technical quality of studies and an independent second reading for angiograms before recommending revascularization.

journal_name

Am Heart J

journal_title

American heart journal

authors

Leape LL,Park RE,Bashore TM,Harrison JK,Davidson CJ,Brook RH

doi

10.1016/s0002-8703(00)90316-8

subject

Has Abstract

pub_date

2000-01-01 00:00:00

pages

106-13

issue

1 Pt 1

eissn

0002-8703

issn

1097-6744

pii

S0002-8703(00)70016-0

journal_volume

139

pub_type

临床试验,杂志文章,多中心研究,随机对照试验

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Effect of variability in the interpretation of coronary angiograms on the appropriateness of use of coronary revascularization procedures.