Author + information
- Anjan Chakrabarti,
- Maria Grau–Sepulveda,
- Sean O'Brien,
- Cassandra Abueg,
- Varun Kumar,
- Lakshmi Gopalakrishnan,
- Meghan E. Doherty,
- Angelo Ponirakis,
- Elizabeth DeLong,
- Eric Peterson,
- Kirk Garratt,
- Fred Edwards,
- William Weintraub and
- C. Michael Gibson
The goal of this study was to compare angiographic interpretation by sites in community practice versus those made by a centralized angiographic core laboratory.
The study population consisted of 2013 consecutive American College of Cardiology National Cardiovascular Data Registry (NCDR®) records with 2– and 3– vessel coronary disease from 54 sites in 2004 to 2007. The primary analysis compared Registry (NCDR®) defined 2– and 3–vessel disease vs. those from an angiographic core laboratory analysis.
Vessel–level kappa coefficients suggested moderate agreement between NCDR® and core lab analysis, ranging from kappa = 0.39 (95% CI 0.32–0.45) for the left anterior descending artery to kappa = 0.59 (95% CI 0.55–0.64) for the right coronary artery. Overall, 6.3% (n= 127/2013) of those patients identified with multi–vessel disease at NCDR® sites had had 0– or 1–vessel disease by core lab reading. The positive predictive value (PPV) of the NCDR® registry for predicting 3–vessel disease was modest at 79.1% (95% CI 76.67%–81.39%). There was no bias with regard to “overcall,” i.e. 3–vessel disease reported by the core lab with < 3–vessel disease reported by the Registry occurred in 13.9% of cases, whereas “overcall” by the Registry occurred in 12.3% of cases.
There was modest agreement between angiographic readings in clinical practice and those from an independent core laboratory. Further study will be needed as the implications for patient management are uncertain.
|NCDR® readings||Core Lab readings|
|LEFT MAIN (Kappa 0.53, 95% CI 0.48–0.59)|
|No Disease*||1684 (83.66%)||17 (0.84%)|
|Disease||177 (8.79%)||135 (6.71%)|
|LAD (Kappa 0.39, 95% CI 0.32–0.45)|
|No Disease||92 (4.57%)||104 (5.17%)|
|Disease||120 (5.96%)||1697 (84.30%)|
|CIRCUMFLEX (Kappa 0.53, 95% CI 0.53–0.57)|
|No Disease||275 (13.66%)||181 (8.99%)|
|Disease||143 (7.10%)||1414 (70.24%)|
|RCA (Kappa 0.59, 95% CI 0.55–0.64)|
|No Disease||221 (10.98%)||98 (4.87%)|
|Disease||128 (6.36%)||1566 (77.79%)|
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.–4:30 p.m.
Session Title: Interventional Aspects of CT and Other Novel Imaging Approaches
Abstract Category: 37. TCT@ACC–i2: Angiography and Interventional Aspects of CT/MR
Presentation Number: 2112–251
- 2013 American College of Cardiology Foundation