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Discrepancy in the assessment of jailed side branch lesions by visual estimation and quantitative coronary angiographic analysis: comparison with fractional flow reserve

Authors
 Dong-Ho Shin  ;  Bon-Kwon Koo  ;  Katsuhisa Waseda  ;  Kyung Woo Park  ;  Hyo-Soo Kim  ;  Maria Corral  ;  Alexandra Lansky  ;  Yasuhiro Honda  ;  William F Fearon  ;  Peter J Fitzgerald 
Citation
 CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Vol.78(5) : 720-726, 2011 
Journal Title
CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS
ISSN
 1522-1946 
Issue Date
2011
MeSH
Analysis of Variance ; Chi-Square Distribution ; Clinical Trials as Topic ; Coronary Angiography* ; Coronary Stenosis/diagnosis* ; Coronary Stenosis/diagnostic imaging ; Coronary Stenosis/physiopathology ; Fractional Flow Reserve, Myocardial* ; Humans ; Myocardial Perfusion Imaging* ; Observer Variation ; Predictive Value of Tests ; Reproducibility of Results ; Severity of Illness Index
Keywords
variability ; coronary angiography ; bifurcation ; side branch
Abstract
OBJECTIVE: We sought to evaluate the variability in the assessment of jailed side branch (SB) lesions by visual estimation and quantitative coronary angiography (QCA) and to compare those results with fractional flow reserve (FFR).

METHODS: Twenty jailed SB lesions with available FFR (median 0.76; range, 0.39-0.94) were selected from the PRESSURE trial. Lesions were assessed by three independent QCA core laboratories with different QCA systems and by three different cardiologist groups (five European bifurcation club members, five Korean experts, and five trainees). Agreements of the continuous measurements were expressed as the intraclass correlation coefficient (ICC) and average coefficient of variance (CV), and those of the categorical values as kappa.

RESULTS: Mean minimum lumen diameter (MLD) and % diameter stenosis differed among the three QCA systems up to 0.30 mm and 9.65%, respectively (P < 0.001). Three QCA systems showed fair agreement for the measurements of reference diameter, % diameter stenosis, MLD, and lesion length (ICC 0.346-0.686, CV 8.7-29.5%), and a poor agreement on stenosis of 75% or more (Fleiss κ 0.14 and mean κ 0.18). Agreements of visual estimation among the three groups were poor to fair (Fleiss κ 0.167-0.367). Sensitivity and specificity for predicting ischemia-inducible lesion (FFR < 0.75) were 64.7% and 48.0% for visual estimation and 56.6% and 56.6% by QCA, respectively. Visual estimation overestimated the % diameter stenosis and functional significance of the lesions compared with QCA (P < 0.001) and FFR (P = 0.036).

CONCLUSIONS: Angiographic assessment of jailed SB lesions by both QCA and visual estimation showed variability. Visual estimation tended to overestimate the severity of jailed SB lesions compared to FFR and QCA.
Full Text
http://onlinelibrary.wiley.com/doi/10.1002/ccd.23049/abstract
DOI
10.1002/ccd.23049
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Shin, Dong Ho(신동호) ORCID logo https://orcid.org/0000-0002-7874-5542
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/95164
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