SYNTAX score reproducibility and variability between interventional cardiologists, core laboratory technicians, and...

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging Analysis

Background:

• The SYNTAX score aids in risk stratification for complex coronary artery disease.
• Reproducibility of the SYNTAX score is crucial for its clinical application.
• Variability in SYNTAX score assessment can impact patient management and trial outcomes.

Purpose of the Study:

• To evaluate the interobserver and intraobserver variability of the SYNTAX score.
• To compare the reproducibility of SYNTAX score assessments between interventional cardiologists (ICs) and angiographic core laboratory (ACL) technicians.
• To identify factors contributing to variability in SYNTAX score interpretation.

Main Methods:

• Three ICs and four ACL technicians independently assessed SYNTAX scores on 30 angiograms after basic training.
• Following intensive training, both groups reassessed 50 additional angiograms.
• Interobserver agreement was quantified using Fleiss κ statistic, with comparisons to quantitative coronary angiography (QCA).

Main Results:

• ACL technicians demonstrated substantial or greater interobserver agreement (κ=0.82-0.84), comparable to QCA.
• ICs showed initially slight agreement (κ=0.33) that improved to substantial (κ=0.76) after advanced training.
• Despite training, ICs underestimated lesion complexity, leading to lower scores than ACL technicians (mean difference=7.5).

Conclusions:

• Experienced ACL technicians achieve highly reproducible SYNTAX score measurements efficiently.
• While IC agreement improves with training, persistent interpretation differences in lesion types necessitate further refinement for routine SYNTAX score use.
• These findings are vital for the reliable implementation of the SYNTAX score in clinical practice and future research.