Abstract
Background: In the last decade, percutaneous coronary intervention (PCI) has evolved toward the treatment of complex disease in patients with multiple comorbidities. Whilst there are several definitions of complexity, it is unclear whether there is agreement between cardiologists in classifying complexity of cases. Inconsistent identification of complex PCI can lead to significant variation in clinical decision‐making.
Aim: This study aimed to determine the inter‐rater agreement in rating the complexity and risk of PCI procedures.
Method: An online survey was designed and disseminated amongst interventional cardiologists by the European Association of Percutaneous Cardiovascular Intervention (EAPCI) board. The survey presented four patient vignettes, with study participants assessing these cases to classify their complexity.
Results: From 215 respondents, there was poor inter‐rater agreement in classifying the complexity level (k = 0.1) and a fair agreement (k = 0.31) in classifying the risk level. The experience level of participants did not show any significant impact on the inter‐rater agreement of rating the complexity level and the risk level. There was good level of agreement between participants in terms of rating 26 factors for classifying complex PCI. The top five factors were (1) impaired left ventricular function, (2) concomitant severe aortic stenosis, (3) last remaining vessel PCI, (4) requirement fort calcium modification and (5) significant renal impairment. Conclusion: Agreement among cardiologists in classifying complexity of PCI is poor, which may lead to suboptimal clinical decision‐making, procedural planning as well as long‐term management. Consensus is needed to define complex PCI, and this requires clear criteria incorporating both lesion and patient characteristics.
Aim: This study aimed to determine the inter‐rater agreement in rating the complexity and risk of PCI procedures.
Method: An online survey was designed and disseminated amongst interventional cardiologists by the European Association of Percutaneous Cardiovascular Intervention (EAPCI) board. The survey presented four patient vignettes, with study participants assessing these cases to classify their complexity.
Results: From 215 respondents, there was poor inter‐rater agreement in classifying the complexity level (k = 0.1) and a fair agreement (k = 0.31) in classifying the risk level. The experience level of participants did not show any significant impact on the inter‐rater agreement of rating the complexity level and the risk level. There was good level of agreement between participants in terms of rating 26 factors for classifying complex PCI. The top five factors were (1) impaired left ventricular function, (2) concomitant severe aortic stenosis, (3) last remaining vessel PCI, (4) requirement fort calcium modification and (5) significant renal impairment. Conclusion: Agreement among cardiologists in classifying complexity of PCI is poor, which may lead to suboptimal clinical decision‐making, procedural planning as well as long‐term management. Consensus is needed to define complex PCI, and this requires clear criteria incorporating both lesion and patient characteristics.
| Original language | English |
|---|---|
| Journal | Catheterization and Cardiovascular Interventions |
| Early online date | 20 May 2023 |
| DOIs | |
| Publication status | Published online - 20 May 2023 |
Bibliographical note
Funding Information:This work is supported by the European Union's INTERREG VA program, managed by the Special EU Programs Body (SEUPB). The views and opinions expressed in this study do not necessarily reflect those of the European Commission or the Special EU Programs Body (SEUPB).
Publisher Copyright:
© 2023 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.
Keywords
- complex procedures
- high risk procedures
- inter rater reliability
- cathlab
- decision making
- clinical decision making
- complex percutaneous coronary intervention
