Paul T Campbell1, Ehtisham Mahmud2, J Jeffrey Marshall3. 1. Sanger Heart & Vascular Institute, Concord, North Carolina. 2. University of California, San Diego, San Diego, California. 3. Northeast Georgia Heart Center, Gainesville, Georgia.
Abstract
OBJECTIVES: The objectives of this study were to evaluate the ability of interventional cardiologists to accurately measure lesion length and select appropriate stents. BACKGROUND: Inaccurate measurement of lesion length during percutaneous coronary intervention (PCI) increases the risk of restenosis. METHODS: Interventional cardiologists (n = 40) evaluated 25 matched orthogonal angiographic images that were prescored using quantitative coronary angiography (QCA) by a core laboratory. Visual estimates of lesion length and stent length selection were compared to the maximum QCA value. A 2-4 mm stent overlap of both the proximal and distal lesion edges was considered to be optimal. Based on optimal stent overlap, accurate lesion lengths were those measured from -1 to +4 mm from the QCA. Likewise, appropriate stent lengths were those that measured between +4 mm to +8 mm from the QCA value. Five images were repeated to assess intrarater variability. RESULTS: Lesion length measurements were short and long for 51.1% (95% CI 47.6-54.6%) and 19.0% (95% CI 16.3-21.9%) of the images, respectively. Stent length selections that were short and long were recorded for 55.0% (95% CI 51.5-58.5%) and 22.8% (95% CI 19.9-25.8%) of the images, respectively. Intrarater variability evaluation indicated that 38.5% (95% CI 31.7-45.6%) of lesion length measurements and 37.5% (95% CI 30.8-44.6%) of stent length selections were >3 mm different between the first and second evaluation of repeated images. CONCLUSIONS: Visual estimation of coronary lesion length has a high degree of variability, which may lead to inappropriate stent selection. Improving the accuracy of lesion length measurement may improve patient outcomes.
OBJECTIVES: The objectives of this study were to evaluate the ability of interventional cardiologists to accurately measure lesion length and select appropriate stents. BACKGROUND: Inaccurate measurement of lesion length during percutaneous coronary intervention (PCI) increases the risk of restenosis. METHODS: Interventional cardiologists (n = 40) evaluated 25 matched orthogonal angiographic images that were prescored using quantitative coronary angiography (QCA) by a core laboratory. Visual estimates of lesion length and stent length selection were compared to the maximum QCA value. A 2-4 mm stent overlap of both the proximal and distal lesion edges was considered to be optimal. Based on optimal stent overlap, accurate lesion lengths were those measured from -1 to +4 mm from the QCA. Likewise, appropriate stent lengths were those that measured between +4 mm to +8 mm from the QCA value. Five images were repeated to assess intrarater variability. RESULTS: Lesion length measurements were short and long for 51.1% (95% CI 47.6-54.6%) and 19.0% (95% CI 16.3-21.9%) of the images, respectively. Stent length selections that were short and long were recorded for 55.0% (95% CI 51.5-58.5%) and 22.8% (95% CI 19.9-25.8%) of the images, respectively. Intrarater variability evaluation indicated that 38.5% (95% CI 31.7-45.6%) of lesion length measurements and 37.5% (95% CI 30.8-44.6%) of stent length selections were >3 mm different between the first and second evaluation of repeated images. CONCLUSIONS: Visual estimation of coronary lesion length has a high degree of variability, which may lead to inappropriate stent selection. Improving the accuracy of lesion length measurement may improve patient outcomes.
Authors: Haibo Zhang; Lin Mu; Shuang Hu; Brahmajee K Nallamothu; Alexandra J Lansky; Bo Xu; Georgios Bouras; David J Cohen; John A Spertus; Frederick A Masoudi; Jeptha P Curtis; Runlin Gao; Junbo Ge; Yuejin Yang; Jing Li; Xi Li; Xin Zheng; Yetong Li; Harlan M Krumholz; Lixin Jiang Journal: JAMA Intern Med Date: 2018-02-01 Impact factor: 21.873
Authors: Jung Min Ahn; Duk Woo Park; Sung Jin Hong; Young Keun Ahn; Joo Yong Hahn; Won Jang Kim; Soon Jun Hong; Chang Wook Nam; Do Yoon Kang; Seung Yul Lee; Woo Jung Chun; Jung Ho Heo; Deok Kyu Cho; Jin Won Kim; Sung Ho Her; Sang Wook Kim; Sang Yong Yoo; Myeong Ki Hong; Seung Jea Tahk; Kee Sik Kim; Moo Hyun Kim; Yangsoo Jang; Seung Jung Park Journal: Korean Circ J Date: 2017-11-06 Impact factor: 3.243