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Determining whether a coronary stenosis warrants an intervention is often based upon interpretation of a diagnostic angiogram, in real time, without using quantitative coronary angiography (QCA). However, visual estimation of the severity of atherosclerotic blockages may vary across individual operators and over-estimation of narrowings could lead to unwarranted percutaneous coronary intervention (PCI). Studies from more than two decades ago suggested substantial variability in the quality of images and accuracy of their interpretation. Little is known about the accuracy of visual estimation in contemporary real-world settings in the digital era.
We have abstracted visual estimations of coronary stenosis from the clinical records of 175 patients undergoing elective PCI from 7 hospitals within the NCDR® CathPCI Registry in 2011. The study angiograms were selected randomly. The study hospitals represented a diverse array of high volume centers across the country. Deidentified images were evaluated at an independent core laboratory (Yale) by experienced personnel, blinded to the clinical interpretation and patient records using established QCA methods (Medis, Leiden). Findings from visual estimation were compared with QCA to determine variation among sites and by patient characteristics. Image quality was also evaluated using standardized criteria.
Mean age of patients is 66.7 (± 10.7) with 59 (33.7%) women. A total of 26 (14.8%) patients were asymptomatic or had symptoms unlikely to be ischemic; 48 (27.4%) patients had stable angina; 87 (49.7%) had unstable angina; and 14 (8.0%) had non-STEMI. Image quality was considered excellent or good in 146 (83.4%) patients. Full results will be available for the ACC Sessions in March 2013.
This study, the first to evaluate the quality of the acquisition and interpretation of coronary angiography in a digital era, will provide information about current angiographic performance at high volume sites. This collaborative across 7 hospitals in the NCDR CathPCI Registry will have findings with important implications for clinical practice, assessing procedural appropriateness and quality improvement.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: New Tests, Targets and Treatments in SIHD
Abstract Category: 10. Chronic CAD/Stable Ischemic Heart Disease: Clinical
Presentation Number: 1240-320
- 2013 American College of Cardiology Foundation