TY - JOUR
T1 - Inter-observer differences in interpretation of coronary pressure-wire pullback data by non-expert interventional cardiologists
AU - Warisawa, Takayuki
AU - Howard, James P.
AU - Cook, Christopher M.
AU - Ahmad, Yousif
AU - Doi, Shunichi
AU - Nakayama, Masafumi
AU - Goto, Sonoka
AU - Yakuta, Yohei
AU - Karube, Kenichi
AU - Seike, Fumiyasu
AU - Uetani, Teruyoshi
AU - Murai, Tadashi
AU - Kikuta, Yuetsu
AU - Shiono, Yasutsugu
AU - Kawase, Yoshiaki
AU - Shun-Shin, Matthew J.
AU - Kaihara, Toshiki
AU - Higuma, Takumi
AU - Ishibashi, Yuki
AU - Matsuda, Hisao
AU - Nishina, Hidetaka
AU - Matsuo, Hitoshi
AU - Escaned, Javier
AU - Akashi, Yoshihiro J.
AU - Davies, Justin E.
N1 - Publisher Copyright:
© 2020, Japanese Association of Cardiovascular Intervention and Therapeutics.
PY - 2021/7
Y1 - 2021/7
N2 - The physiological pattern of coronary artery disease as determined by pressure-wire (PW)-pullback is important for decision-making of revascularization and risk stratification of patients. However, it remains unclear whether inter-observer differences in interpreting PW-pullback data are subject to the expertise of physicians. This study sought to investigate the subjectivity of this assessment among non-experts. Expert interventional cardiologists classified 545 PW-pullback traces into physiologically focal or physiologically diffuse disease pattern. Defining expert-consensus as the reference standard, we evaluated ten non-expert doctors’ classification performance. Observers were stratified equally by two ways: (i) years of experience as interventional cardiologists (middle-level vs. junior-level) and (ii) volume of institutions where they belonged to (high-volume center vs. low-volume center). When judged against the expert-consensus, the agreement of non-expert observers in assessing physiological pattern of disease (focal or diffuse) ranged from 69.1 to 85.0% (p for heterogeneity < 0.0001). There was no evidence for a moderating effect of years of experience; the pooled accuracy of middle-level doctors was 78.8% (95% confidential interval [CI] 72.8–84.7%) vs. 79.1% for junior-level doctors (95% CI 75.9–82.2%, p = 0.95 for difference). On the other hand, we observed a significant moderating effect of center volume. Accuracy across non-experts in high-volume centers was 82.7% (95% CI 80.3–85.1%) vs. 75.1% for low-volume centers (95% CI 71.9–78.3%, p = 0.0002 for difference). Interpretation of PW-pullback by non-expert interventional cardiologists was considerably subjective.
AB - The physiological pattern of coronary artery disease as determined by pressure-wire (PW)-pullback is important for decision-making of revascularization and risk stratification of patients. However, it remains unclear whether inter-observer differences in interpreting PW-pullback data are subject to the expertise of physicians. This study sought to investigate the subjectivity of this assessment among non-experts. Expert interventional cardiologists classified 545 PW-pullback traces into physiologically focal or physiologically diffuse disease pattern. Defining expert-consensus as the reference standard, we evaluated ten non-expert doctors’ classification performance. Observers were stratified equally by two ways: (i) years of experience as interventional cardiologists (middle-level vs. junior-level) and (ii) volume of institutions where they belonged to (high-volume center vs. low-volume center). When judged against the expert-consensus, the agreement of non-expert observers in assessing physiological pattern of disease (focal or diffuse) ranged from 69.1 to 85.0% (p for heterogeneity < 0.0001). There was no evidence for a moderating effect of years of experience; the pooled accuracy of middle-level doctors was 78.8% (95% confidential interval [CI] 72.8–84.7%) vs. 79.1% for junior-level doctors (95% CI 75.9–82.2%, p = 0.95 for difference). On the other hand, we observed a significant moderating effect of center volume. Accuracy across non-experts in high-volume centers was 82.7% (95% CI 80.3–85.1%) vs. 75.1% for low-volume centers (95% CI 71.9–78.3%, p = 0.0002 for difference). Interpretation of PW-pullback by non-expert interventional cardiologists was considerably subjective.
KW - Instantaneous wave-free ratio
KW - Physiological pattern of disease
KW - Pressure-wire pullback
UR - http://www.scopus.com/inward/record.url?scp=85084978263&partnerID=8YFLogxK
U2 - 10.1007/s12928-020-00673-3
DO - 10.1007/s12928-020-00673-3
M3 - Article
C2 - 32430763
AN - SCOPUS:85084978263
SN - 1868-4300
VL - 36
SP - 289
EP - 297
JO - Cardiovascular Intervention and Therapeutics
JF - Cardiovascular Intervention and Therapeutics
IS - 3
ER -