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Registry, core lab data show modest agreement in angiographic readings
Only a modest agreement was reported between angiographic readings in clinical practice and those observed by an independent core lab, according to recent findings.
Researchers of the study, which was published in Circulation: Cardiovascular Interventions, culled data from the 2013 American College of Cardiology–National Cardiovascular Data Registry to compare angiographic interpretation of coronary arteriograms in community settings with those made in a centralized angiographic core laboratory. Findings from 54 sites between 2004 and 2007 were included in the analysis.
Eligible participants had two- and three-vessel coronary disease.
The primary analysis compared eligible participants from the registry with those from an angiographic core lab.
There was only moderate agreement between registry and laboratory analyses, according to vessel-kappa coefficient data. The range was from kappa=0.39 (95% CI, 0.32-0.45) for the left anterior descending artery to kappa=0.59 (95% CI, 0.55-0.64) for the right coronary artery.
Among 2,013 patients identified by the registry as having multivessel disease, 127 (6.3%) were identified by core laboratory testing as having zero- or one-vessel disease.
The investigators did not observe directional bias in terms of overcall, according to the investigators. Among cases that read as three-vessel disease by the sites, 12.3% were read as less than three-vessel disease by the core laboratory. For the other comparison, 13.9% of cases identified as three-vessel disease by the core laboratory were read as less than three-vessel disease by the sites.
Registry overcall was not associated with death or MI in the subset of patients with left main disease.
“These findings demonstrate at best moderate consistency between registry data and core laboratory analysis with regard to patients with two- and three-vessel coronary artery disease, a cohort of patients where selection of revascularization strategy is imperative,” the investigators wrote.
Disclosure: The researchers report financial disclosures with Amarin, Bayer, Biogen Idec, Boehringer Ingelheim, BRCI, Bristol-Myers Squibb, CSL Behring, Daiichi Sankyo, Eli Lilly, Genentech, GlaxoSmithKline, Ischemix, Janssen, Johnson & Johnson, Lantheus Medical Imaging, Merck, Ortho McNeil, Pfizer, Portola Pharmaceuticals, Regado Biosciences, Roche Diagnostics, Sanofi Aventis, St. Jude Medical and The Medicines Company. See the study for the full disclosure list.