The Accuracy Of Clinicians In Assessing The Degree Of Coronary Artery Stenosis And Its Influencing Factors

ObjectiveCoronary angiography is the "gold standard" to assess the pathological changes of coronary arteries, especially coronary stenosis. Quantitative Coronary Angiography (QCA)- a computer assisted technique which is more accurate in assessing coronary stenosis. The severity of a coronary stenosis remains a "key role" in the final clinical decision making. However, it is still typically determined during or shortly after the procedure, and most commonly relies on visual assessment by the physician. Apparently visual assessment has "inaccuracies" - intraobsever and interobserver variance -which may affect the decision making. But the accuracy of the visual assess in complex coronary disease by a physician in contemporary clinical practice, and the factors that could influence the accuracy of visual assessment still remains unknown. This study intends to describe the accuracy of visual assess in complex coronary disease and discuss the factors that impact the accuracy of physician’s interpretation.MethodsWe randomly selected patients national wide from the China Peace-3VD study and collected their clinical information including the coronary angiography report. We estimate the severity of the stenosis with a computer assisted technique - quantitative coronary angiography (QCA). The operator were blinded to the severity of visual assess by the physician. Then we compared physician’s interpretation of stenosis severity with the result of QCA. The difference between the physician and QCA were used to measure the accuracy of clinical interpretation. Subgroup analysis and multifactor analysis were used to discuss the factors that impact the accuracy of clinical interpretation.ResultsFrom Sep.2011 to Jul.2013, twenty-five centers participate the China Peace-3VD study and 109 patients were enrolled in this study from five of the centers national wide. Then we analyzed 501 coronary stenosis lesions of these patients. The study indicates: QCA tend to underestimate the severity of a stenosis lesion compared with physician’s interpretation (70.7%±17.4% vs 79.1%±15.3%), the difference has statistical significance (8.41%±10.5%, p<0.001). Subgroup and multifactor analysis show that the difference of physician and QCA in lesion treated with ad hoc PCI is larger than those lesion who were not treated instantly (10.6±10.3 vs 7.90±10.5, p=0.025); The difference of physician and QCA differs from one hospital to another (6.25±9.95 to 12.5±11.1, p<0.001); The difference of physician and QCA is larger in patients who had a sever angina (CCS grading≥2,9.34±10.7 vs 5.41 ±9.43, p<0.001). In addition:diffuse lesion, reference vessel diameter, lesion location has an impact on the difference between the physician and QCA, while lesion length, bifurcation, angulation, sever calcification and patients’ age, gender doesn’t make a difference.ConclusionsThe accuracy of a physician’s interpretation of coronary angiography is not only influenced by objective factors such as the actual severity of stenosis, diffuse lesion etc. but also subjective factors such as if the lesion were treated instantly, the severity of the patient’s symptom and hospital level.