Inter-observer differences in interpretation of coronary pressure-wire pullback data by non-expert interventional...

Area of Science:

• Cardiology
• Medical Imaging
• Interventional Cardiology

Background:

• Pressure-wire (PW)-pullback analysis is crucial for diagnosing coronary artery disease (CAD) patterns, guiding revascularization decisions and patient risk stratification.
• The reliability of PW-pullback interpretation, particularly concerning inter-observer variability among non-expert physicians, remains an area requiring investigation.

Purpose of the Study:

• To assess the subjectivity of PW-pullback data interpretation by non-expert interventional cardiologists in classifying coronary artery disease patterns.
• To investigate whether physician experience level or institutional volume moderates the accuracy of PW-pullback interpretation.

Main Methods:

• Expert interventional cardiologists established a consensus reference standard for 545 PW-pullback traces, classifying them as physiologically focal or diffuse disease.
• Ten non-expert cardiologists, stratified by years of experience (middle-level vs. junior-level) and institutional volume (high-volume vs. low-volume centers), classified the same traces.
• Agreement rates and accuracy were evaluated against the expert consensus, with statistical analysis for heterogeneity and moderating effects.

Main Results:

• Non-expert observers showed a wide range of agreement with the expert consensus, from 69.1% to 85.0%.
• No significant difference in pooled accuracy was observed between middle-level (78.8%) and junior-level (79.1%) cardiologists.
• Accuracy was significantly higher for non-experts practicing in high-volume centers (82.7%) compared to those in low-volume centers (75.1%).

Conclusions:

• The interpretation of PW-pullback data for assessing coronary artery disease patterns is considerably subjective among non-expert interventional cardiologists.
• Physician experience, measured by years in practice, did not significantly influence the accuracy of PW-pullback interpretation.
• The volume of the institution where a cardiologist practices significantly impacts the accuracy of PW-pullback interpretation, suggesting a potential role for specialized training or higher patient volume in improving diagnostic reliability.