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 ≥50% diameter stenosis (except for right coronary lesions) and underestimated severity in all arteries with <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 < 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 < 0.001) overestimated initial lesion severity and underestimated stenosis severity after angioplasty.