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What do we mean by complex percutaneous coronary intervention? An assessment of agreement amongst interventional
Khaled Rjoob1, Victoria McGilligan2, Roisin McAllister2
1Faculty of Computing, Engineering & Built Environment, Ulster University, Northern Ireland, UK.
Insights
Cardiologists show poor agreement on classifying complex percutaneous coronary intervention (PCI) cases, impacting clinical decisions. Defining complex PCI with clear criteria is crucial for consistent patient management.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Clinical Decision-Making
Background:
- Percutaneous coronary intervention (PCI) increasingly treats complex cases in patients with comorbidities.
- Lack of consensus on defining complex PCI leads to varied clinical decision-making.
- Current definitions of complex PCI may not be consistently applied by practitioners.
Purpose of the Study:
- To assess inter-rater agreement among cardiologists in classifying PCI complexity and risk.
- To identify factors contributing to the complexity of PCI procedures.
- To evaluate the impact of experience on agreement in PCI case classification.
Main Methods:
- An online survey was distributed to interventional cardiologists via the European Association of Percutaneous Cardiovascular Intervention (EAPCI) board.
- Participants evaluated four patient vignettes to classify PCI complexity and risk.
- Survey responses from 215 interventional cardiologists were analyzed for inter-rater reliability.
Main Results:
- Poor inter-rater agreement was found for PCI complexity (k=0.1) and fair agreement for risk (k=0.31).
- Cardiologist experience did not significantly influence agreement on complexity or risk ratings.
- High agreement was observed in rating specific factors for complex PCI, including impaired left ventricular function and severe aortic stenosis.
Conclusions:
- Poor agreement in classifying complex PCI may result in suboptimal clinical decision-making and patient management.
- There is a need for consensus on defining complex PCI, integrating lesion and patient characteristics.
- Standardized criteria are essential for consistent procedural planning and long-term care in complex PCI cases.
Background:
In the last decade, percutaneous coronary intervention (PCI) has evolved toward the treatment of complex disease in patients with multiple comorbidities. Whilst there are several definitions of complexity, it is unclear whether there is agreement between cardiologists in classifying complexity of cases. Inconsistent identification of complex PCI can lead to significant variation in clinical decision-making.
Aim:
This study aimed to determine the inter-rater agreement in rating the complexity and risk of PCI procedures.
Method:
An online survey was designed and disseminated amongst interventional cardiologists by the European Association of Percutaneous Cardiovascular Intervention (EAPCI) board. The survey presented four patient vignettes, with study participants assessing these cases to classify their complexity.
Results:
From 215 respondents, there was poor inter-rater agreement in classifying the complexity level (k = 0.1) and a fair agreement (k = 0.31) in classifying the risk level. The experience level of participants did not show any significant impact on the inter-rater agreement of rating the complexity level and the risk level. There was good level of agreement between participants in terms of rating 26 factors for classifying complex PCI. The top five factors were (1) impaired left ventricular function, (2) concomitant severe aortic stenosis, (3) last remaining vessel PCI, (4) requirement fort calcium modification and (5) significant renal impairment.
Conclusion:
Agreement among cardiologists in classifying complexity of PCI is poor, which may lead to suboptimal clinical decision-making, procedural planning as well as long-term management. Consensus is needed to define complex PCI, and this requires clear criteria incorporating both lesion and patient characteristics.
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