Abstract
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.
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TW has received consulting fees from Philips Japan and Abbott Vascular Japan. JPH is supported by the Wellcome Trust (212183/Z/18/Z). CMC has received speaker’s honoraria from Philips. YA is supported by the Academy of Medical Sciences and Imperial Biomedical Research Centre. YK reports speaker fees from Abbott Vascular and Philips. YS has received speaker’s and manuscript’s honoraria from Philips. JED holds patents pertaining to the iFR technology. JED is a consultant for Philips and has received research grants from Philips. All other authors declare no competing interests.
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Warisawa, T., Howard, J.P., Cook, C.M. et al. Inter-observer differences in interpretation of coronary pressure-wire pullback data by non-expert interventional cardiologists. Cardiovasc Interv and Ther 36, 289–297 (2021). https://doi.org/10.1007/s12928-020-00673-3
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DOI: https://doi.org/10.1007/s12928-020-00673-3