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

Dong Ho Shin, Bonkwon Koo, Katsuhisa Waseda, Kyung Woo Park, Hyo-Soo Kim, Maria Corral, Alexandra Lansky, Yasuhiro Honda, William F. Fearon, Peter J. Fitzgerald

Research output: Contribution to journalArticle

15 Citations (Scopus)

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. © 2011 Wiley Periodicals, Inc.

Original languageEnglish
Pages (from-to)720-726
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume78
Issue number5
DOIs
StatePublished - 1 Nov 2011

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Coronary Angiography
Pathologic Constriction
Ischemia
Sensitivity and Specificity

Keywords

  • bifurcation
  • coronary angiography
  • side branch
  • variability

Cite this

@article{87f0f8df072e4e52ae919dd4bce7eddc,
title = "Discrepancy in the assessment of jailed side branch lesions by visual estimation and quantitative coronary angiographic analysis: Comparison with fractional flow reserve",
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. {\circledC} 2011 Wiley Periodicals, Inc.",
keywords = "bifurcation, coronary angiography, side branch, variability",
author = "Shin, {Dong Ho} and Bonkwon Koo and Katsuhisa Waseda and Park, {Kyung Woo} and Hyo-Soo Kim and Maria Corral and Alexandra Lansky and Yasuhiro Honda and Fearon, {William F.} and Fitzgerald, {Peter J.}",
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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. / Shin, Dong Ho; Koo, Bonkwon; Waseda, Katsuhisa; Park, Kyung Woo; Kim, Hyo-Soo; Corral, Maria; Lansky, Alexandra; Honda, Yasuhiro; Fearon, William F.; Fitzgerald, Peter J.

In: Catheterization and Cardiovascular Interventions, Vol. 78, No. 5, 01.11.2011, p. 720-726.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Discrepancy in the assessment of jailed side branch lesions by visual estimation and quantitative coronary angiographic analysis

T2 - Comparison with fractional flow reserve

AU - Shin, Dong Ho

AU - Koo, Bonkwon

AU - Waseda, Katsuhisa

AU - Park, Kyung Woo

AU - Kim, Hyo-Soo

AU - Corral, Maria

AU - Lansky, Alexandra

AU - Honda, Yasuhiro

AU - Fearon, William F.

AU - Fitzgerald, Peter J.

PY - 2011/11/1

Y1 - 2011/11/1

N2 - 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. © 2011 Wiley Periodicals, Inc.

AB - 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. © 2011 Wiley Periodicals, Inc.

KW - bifurcation

KW - coronary angiography

KW - side branch

KW - variability

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U2 - 10.1002/ccd.23049

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SN - 1522-1946

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