Patterns in visual interpretation of coronary arteriograms as detected by quantitative coronary arteriography

Abstract

In part 1 of a three-part study, 14 novice readers and 6 experienced cardiologists interpreted phantom images of known stenosis severity. No difference between the interpretations of experienced and novice readers was detectable. Visual estimates of "moderately" severe stenosis were 30% higher than actual percent diameter stenosis. In part 2 of the study, visual interpretation of percent diameter stenosis from 212 stenoses on 241 arteriograms was compared with quantitative coronary arteriographic assessment. The visual analysis overestimated disease severity in arteries with greater than or equal to 50% diameter stenosis (except for right coronary lesions) and underestimated severity in all arteries with less than 50% diameter stenosis. Of the 241 arteriograms, 40 had quantitative and visual analysis of all three coronary arteries for assessment of significant disease. In only 62% of the cases did visual and quantitative methods agree on the presence of severe disease; visual estimates diagnosed significantly (p less than 0.05) more three-vessel disease. In part 3 of the study, comparison of percent diameter stenosis by visual estimate with quantitative coronary arteriographic assessment before and after balloon angioplasty of 38 stenoses showed that visual interpretation significantly (p less than 0.001) overestimated initial lesion severity and underestimated stenosis severity after angioplasty.

Visual and Quantitative Assessment of Coronary Stenoses at Angiography Versus Fractional Flow Reserve

“…Our results were similar and confirm in a larger population previous studies describing the difference observed between VE and QCA. [34][35][36] …”

Impact of Angiographic Residual Stenosis on Clinical Outcomes After New‐Generation Drug‐Eluting Stents Implantation: Insights From a Pooled Analysis of the RESET and NEXT Trials

“…Third, QCA is mainly used for research purposes, and is rarely performed in daily clinical practice, where the degree of stenosis is intuitively judged by the visual estimation. Visual assessment overestimates stenosis more than QCA measurement in highly stenotic lesions, while it underestimates stenosis in mildly stenotic ones 20, 21. It could be possible that the suboptimal results might be underestimated by visual estimation.…”

A Decade of Improvement in the Clinical Outcomes of Percutaneous Coronary Intervention for Multivessel Coronary Artery Disease

“…This difference in methodology may have contributed to the marked improvements in angiographic success rates (from 72% to 91% in the Dynamic Registry), because absolute differences of 10% to 20% are expected between Core Laboratory and clinical site readings. 7 The different angiographic measurement methodologies may also explain the observed differences in reference vessel size and preprocedural percent stenosis between the 2 groups, 8 while precluding use of reference vessel size or posttreatment lumen diameter-important predictors of subsequent restenosis-in multivariable models of repeat revascularization.…”