Inter-observer reliability in the interpretation of coronary angiograms

Area of Science:

• Cardiology
• Medical Imaging
• Surgical Assessment

Background:

• Coronary angiogram interpretation is crucial for coronary surgery decisions.
• Variability in interpretation can impact surgical outcomes.
• Assessing surgeon reliability is key to standardizing care.

Purpose of the Study:

• To evaluate the inter-observer reliability of cardiac surgeons in interpreting coronary angiograms.
• To assess agreement on surgical procedure recommendations and operative risk evaluation.
• To identify areas of high and low agreement among surgeons.

Main Methods:

• Eight cardiac surgeons interpreted ten coronary angiograms.
• A two-way random factor analysis of variance was used to evaluate coding discrepancies.
• Intraclass correlation coefficients (ICCs) measured agreement on stenosis, collateral supply, bypass recommendations, wall motion, ejection fraction, and operative risk.

Main Results:

• Substantial reliability was found for stenosis assessment (ICC 0.92-1) and collateral supply (ICC 0.75-0.94).
• Good agreement existed for the number of bypasses (ICC = 0.88) and ejection fraction (ICC = 0.93).
• Agreement varied for specific artery bypass decisions (ICC 0.60-0.92) and wall motion assessment (ICC 0.78-0.98).

Conclusions:

• Cardiac surgeons demonstrate substantial to good reliability in interpreting coronary angiograms and assessing operative risk.
• While overall agreement is high, minor discrepancies exist in specific anatomical revascularization and regional wall motion assessments.
• Standardized training may enhance consistency in surgical decision-making.