Jon-David R Schwalm1, Harindra C Wijeysundera2, Jack V Tu2, Helen Guo3, Kori J Kingsbury4, Madhu K Natarajan5. 1. McMaster University/Hamilton Health Sciences/Population Health Research Institute, Hamilton, Ontario, Canada. Electronic address: schwalj@mcmaster.ca. 2. Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 3. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 4. Cardiac Care Network, Toronto, Ontario, Canada. 5. McMaster University/Hamilton Health Sciences/Population Health Research Institute, Hamilton, Ontario, Canada.
Abstract
BACKGROUND: The Variation in Revascularization Practice in Ontario (VRPO) project helped describe variations in revascularization across Ontario. Coronary anatomy was the most important predictor of revascularization strategy. We conducted a novel angiographic substudy of the VRPO cohort to: (1) validate "real-world" coronary angiographic reporting in the province of Ontario; and (2) understand the relationship between variability in revascularization and coronary anatomy complexity. METHODS: Seventeen hundred eighty-seven angiograms from 17 cardiac centres were randomly sampled from the VRPO cohort. The core lab assessment involved blinded interpretation of each angiographic film. A comparison of agreement in coronary anatomy and treatment strategy between abstracted chart data from the VRPO study and blinded film review was undertaken. Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) scores were calculated for all patients with multivessel disease. RESULTS: The weighted κ statistic for coronary anatomy was 0.75 (95% confidence interval, 0.72-0.77), suggesting substantial agreement between abstracted chart data and blinded film review. The weighted κ for revascularization strategy was 0.51 (95% confidence interval, 0.47-0.54) suggesting only moderate agreement. There were no significant differences in the mean/median SYNTAX scores across all 4 percutaneous coronary intervention: coronary artery bypass graft (CABG) groups. CONCLUSIONS: Abstracted chart data in the VRPO project provides a valid assessment of coronary anatomy and furthermore serves as validation of "real-world" coronary angiographic reporting in the province of Ontario. The uniform distribution of coronary complexity across centres in Ontario, with respect to the SYNTAX score, suggests the variation of percutaneous coronary intervention: CABG ratio is not related to a difference in coronary anatomy complexity across sites, but rather a difference in management strategies for the same anatomy.
BACKGROUND: The Variation in Revascularization Practice in Ontario (VRPO) project helped describe variations in revascularization across Ontario. Coronary anatomy was the most important predictor of revascularization strategy. We conducted a novel angiographic substudy of the VRPO cohort to: (1) validate "real-world" coronary angiographic reporting in the province of Ontario; and (2) understand the relationship between variability in revascularization and coronary anatomy complexity. METHODS: Seventeen hundred eighty-seven angiograms from 17 cardiac centres were randomly sampled from the VRPO cohort. The core lab assessment involved blinded interpretation of each angiographic film. A comparison of agreement in coronary anatomy and treatment strategy between abstracted chart data from the VRPO study and blinded film review was undertaken. Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) scores were calculated for all patients with multivessel disease. RESULTS: The weighted κ statistic for coronary anatomy was 0.75 (95% confidence interval, 0.72-0.77), suggesting substantial agreement between abstracted chart data and blinded film review. The weighted κ for revascularization strategy was 0.51 (95% confidence interval, 0.47-0.54) suggesting only moderate agreement. There were no significant differences in the mean/median SYNTAX scores across all 4 percutaneous coronary intervention: coronary artery bypass graft (CABG) groups. CONCLUSIONS: Abstracted chart data in the VRPO project provides a valid assessment of coronary anatomy and furthermore serves as validation of "real-world" coronary angiographic reporting in the province of Ontario. The uniform distribution of coronary complexity across centres in Ontario, with respect to the SYNTAX score, suggests the variation of percutaneous coronary intervention: CABG ratio is not related to a difference in coronary anatomy complexity across sites, but rather a difference in management strategies for the same anatomy.
Authors: Jaskaran S Kang; Maria C Bennell; Feng Qiu; Merril L Knudtson; Peter C Austin; Dennis T Ko; Harindra C Wijeysundera Journal: CMAJ Open Date: 2016-08-08
Authors: Idan Roifman; Harindra C Wijeysundera; Peter C Austin; Mohammad R Rezai; Graham A Wright; Jack V Tu Journal: J Am Heart Assoc Date: 2017-07-19 Impact factor: 5.501
Authors: Talal Aljabbary; Feng Qiu; Shannon Masih; Jiming Fang; Gabby Elbaz-Greener; Peter C Austin; Josep Rodés-Cabau; Dennis T Ko; Sheldon Singh; Harindra C Wijeysundera Journal: JAMA Netw Open Date: 2018-05-18
Authors: Michael B Tsang; J D Schwalm; Sumeet Gandhi; Matthew G Sibbald; Amiram Gafni; Mathew Mercuri; Omid Salehian; Andre Lamy; Dan Pericak; Sanjit Jolly; Tej Sheth; Craig Ainsworth; James Velianou; Nicholas Valettas; Shamir Mehta; Natalia Pinilla; Bobby Yanagawa; Li Zhang; Victor Chu; Dominic Parry; Richard Whitlock; Adel Dyub; Irene Cybulsky; Lloyd Semelhago; Kostas Ioannou; Adnan Hameed; Douglas Wright; Amin Mulji; Saeed Darvish-Kazem; Nandini Gupta; Ahmed Alshatti; Madhu K Natarajan Journal: JAMA Netw Open Date: 2020-08-03