Effect of variability in the interpretation of coronary angiograms on the appropriateness of use of coronary revascularization procedures☆,☆☆,★
Section snippets
Sample
We selected 3 samples of angiograms for review from our previously reported study of the appropriateness of coronary angiography, CABG, and PTCA in 1990 in nonfederal hospitals in New York State.
To evaluate variation in assessing the extent of disease, we sampled angiograms from the study of appropriateness of angiography.13 For that study, patients were selected by a 2-step sampling process. Hospitals were randomly sampled from several strata: geographic location, number of angiographies
Adequacy of angiograms
Although in most cases it was possible for Duke angiographers to visually interpret lesions despite technical deficiencies, in 7 cases the technical quality of the study was so poor that adequate visual assessment of the lesions was impossible. In another 5 cases, major epicardial vessels were not injected. These cases were excluded. In 1 previous angiography case, clinical data were inadequate to permit classification for appropriateness of revascularization; therefore it was also excluded,
Discussion
Cardiologists have wrestled with the problem of reproducibility of visual angiographic interpretation of lesion severity for more than 2 decades. The lack of agreement between readers has been disturbingly high as well as remarkably consistent. In 1975, Detre et al6 reported the results of a study in which 22 physicians interpreted 13 angiograms on 2 separate occasions. They found interobserver agreement on extent of disease to be approximately halfway between 100% and chance, and intraobserver
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Guest Editor for this manuscript was Blase A. Carabello, MD, Medical University of South Carolina, Charleston.
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Reprint requests: Lucian L. Leape, MD, Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115.
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