Subject(s)
Cardiology , United States , Humans , American Heart Association , Research Report , Health PolicySubject(s)
Cardiology , Government Regulation , Health Care Reform/legislation & jurisprudence , Cardiology/education , Cardiology/legislation & jurisprudence , Cardiology/organization & administration , Congresses as Topic , Humans , Liability, Legal , Physician Payment Review Commission , United StatesSubject(s)
Cardiology/organization & administration , Cardiovascular Diseases , Delivery of Health Care , Cardiovascular Diseases/economics , Cardiovascular Diseases/epidemiology , Delivery of Health Care/organization & administration , Delivery of Health Care/statistics & numerical data , Health Care Reform , Humans , Insurance, Health, Reimbursement/statistics & numerical data , Medical Informatics , Risk Assessment , Risk Factors , Specialty Boards/statistics & numerical data , United StatesABSTRACT
BACKGROUND: Studies conducted decades ago described substantial disagreement and errors in physicians' angiographic interpretation of coronary stenosis severity. Despite the potential implications of such findings, no large-scale efforts to measure or improve clinical interpretation were subsequently undertaken. METHODS AND RESULTS: We compared clinical interpretation of stenosis severity in coronary lesions with an independent assessment using quantitative coronary angiography (QCA) in 175 randomly selected patients undergoing elective percutaneous coronary intervention at 7 US hospitals in 2011. To assess agreement, we calculated mean difference in percent diameter stenosis between clinical interpretation and QCA and a Cohen weighted κ statistic. Of 216 treated lesions, median percent diameter stenosis was 80.0% (quartiles 1 and 3, 80.0% and 90.0%), with 213 (98.6%) assessed as ≥70%. Mean difference in percent diameter stenosis between clinical interpretation and QCA was 8.2±8.4%, reflecting an average higher percent diameter stenosis by clinical interpretation (P<0.001). A weighted κ of 0.27 (95% confidence interval, 0.18-0.36) was found between the 2 measurements. Of 213 lesions considered ≥70% by clinical interpretation, 56 (26.3%) were <70% by QCA, although none were <50%. Differences between the 2 measurements were largest for intermediate lesions by QCA (50% to <70%), with variation existing across sites. CONCLUSIONS: Physicians tended to assess coronary lesions treated with percutaneous coronary intervention as more severe than measurements by QCA. Almost all treated lesions were ≥70% by clinical interpretation, whereas approximately one quarter were <70% by QCA. These findings suggest opportunities to improve clinical interpretation of coronary angiography.