Document Detail


How good are experienced interventional cardiologists at predicting the functional significance of intermediate or equivocal left main coronary artery stenoses?
MedLine Citation:
PMID:  17346818     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Decisions for coronary revascularisation are frequently based on visual assessment of the severity of a stenosis. In patients with intermediate left main stem lesions clinical decision making based on FFR is safe and feasible. This study was performed to assess the accuracy of visual angiographic assessment of intermediate or equivocal left main coronary artery (LMCA) stenoses by experienced interventional cardiologists when taking fractional flow reserve (FFR) measurements as the gold standard. METHODS: Fifty-one patients with intermediate (40-80% diameter stenosis by angiography) or equivocal LMCA disease were evaluated by FFR. Angiograms were then reviewed by 4 experienced interventionalists from different university hospitals blinded to FFR results. Lesions were visually assessed and their significance classified as 'significant', 'not significant', or 'unsure' if the observer was unable to make a decision regarding lesion significance based on the angiogram. RESULTS: Results were compared with two different FFR cutoff values (< 0.75 and < or = 0.80) for hemodynamic significance. The 4 reviewers achieved correct lesion classification in no more than approximately 50% of cases each, regardless of FFR threshold. The interobserver agreement between two reviewers in excess of the agreement expected due to chance was outperformed on average by only 16%. Furthermore, interobserver variability was large resulting in unanimously correct lesion classification in only 29% of all cases. CONCLUSIONS: The functional significance of intermediate and equivocal LMCA stenoses should not be based solely on angiographic assessment even by experienced interventional cardiologists.
Authors:
Michael Lindstaedt; Martin Spiecker; Christian Perings; Thomas Lawo; Aydan Yazar; Tim Holland-Letz; Andreas Muegge; Waldemar Bojara; Alfried Germing
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Publication Detail:
Type:  Journal Article     Date:  2007-03-07
Journal Detail:
Title:  International journal of cardiology     Volume:  120     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-07-16     Completed Date:  2007-08-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  254-61     Citation Subset:  IM    
Affiliation:
Medical Clinic II, University Hospital Bergmannsheil, Bochum, Germany. michael.lindstaedt@rub.de
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MeSH Terms
Descriptor/Qualifier:
Blood Flow Velocity / physiology*
Blood Pressure / physiology*
Cardiology / standards*
Clinical Competence*
Coronary Angiography
Coronary Stenosis / diagnosis*,  physiopathology
Coronary Vessels / physiopathology*
Female
Humans
Male
Middle Aged
Observer Variation
Prognosis
Severity of Illness Index

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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