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Reproducibility of coronary arteriographic reading in the coronary artery surgery study (CASS)
Insights
Interpreting coronary arteriograms showed variability, especially for left main coronary artery lesions. However, overall reproducibility improved, with standardized readings and better film quality enhancing consistency in assessing coronary artery disease.
Area of Science:
- Cardiology
- Medical Imaging
- Clinical Trials
Background:
- Coronary arteriography is crucial for diagnosing coronary artery disease (CAD).
- Reproducibility in interpreting arteriograms is essential for consistent patient management and clinical trial validity.
- The Coronary Artery Surgery Study (CASS) provided a large dataset for evaluating interpretation variability.
Purpose of the Study:
- To assess the inter-reader reproducibility of coronary arteriogram interpretations within the CASS registry.
- To identify specific coronary segments or lesion types with the lowest reproducibility.
- To evaluate factors influencing interpretation consistency, such as image quality and reader experience over time.
Main Methods:
- Independent readings of 870 coronary arteriograms by two readers at different clinics.
- Analysis of reproducibility for left main coronary artery lesions and overall number of diseased vessels (>=70% stenosis).
- Comparison of reproducibility based on arteriogram quality (good/acceptable vs. poor/incomplete) and changes over the study enrollment period (1975-1978).
Main Results:
- Interpretation of left main coronary artery lesions demonstrated the least reproducibility (P < .02).
- A significant stenosis (>=50%) in the left main artery was missed by a second reader in 18.6% of cases.
- High agreement was observed for the number of significantly diseased vessels (same or differing by one vessel in 94.7% of readings).
- Reproducibility was better for good quality/complete studies compared to poor quality/incomplete ones.
- The mean absolute difference in percent stenosis readings decreased from 1975 to 1978.
Conclusions:
- While left main coronary artery interpretation poses challenges, overall reproducibility in assessing coronary artery disease is generally high.
- Improvements in arteriogram quality and standardized reading protocols likely contributed to enhanced consistency over time.
- Standardization efforts are vital for improving the reliability of coronary arteriogram interpretation in clinical practice and research.
Abstract:
Eight hundred seventy arteriograms from the Coronary Artery Surgery Study (CASS) were independently read by readers at two different clinics to evaluate the reproducibility of the interpretation of coronary arteriograms. Among proximal segments, the interpretation of lesions of the left main coronary artery were the least reproducible, P less than .02. When one angiographer reads a stenosis of 50% or more in the left main coronary artery, it is estimated that a second reader will report no lesion 18.6% of the time. In 94.7% of the films, the number of significantly (greater than or equal to 70% stenosis) diseased vessels was the same for both readers (72.1%) or differed by one vessel (22.6%). The reproducibility of interpretation of films of good or acceptable quality or completeness was better than the reproducibility of readings of arteriograms judged to be of poor quality or incomplete studies. The mean absolute difference between readings of the percent stenosis decreased over the time of the patient enrollment, 1975 to 1978. This may have resulted from major collaborative efforts made during the course of the study to improve the quality of angiography and to standardize the reading of the cine films.