What do we mean by complex percutaneous coronary intervention? An assessment of agreement amongst interventional cardiologists for defining complexity

Khaled Rjoob, V. E. McGilligan, roisin Mcallister, RR Bond, Gemina Doolub, Stephen J Leslie, Matthew Manktelow, Charles Knoery, James Shand, Aleeha Iftikhar, Anne McShane, Mamas A. Mamas, Aaron Peace

Research output: Contribution to journalArticlepeer-review

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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.
Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Issue number1
Early online date20 May 2023
Publication statusPublished (in print/issue) - 1 Jul 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.


  • complex procedures
  • high risk procedures
  • inter rater reliability
  • cathlab
  • decision making
  • clinical decision making
  • complex percutaneous coronary intervention
  • Radiology, Nuclear Medicine and imaging
  • General Medicine
  • Cardiology and Cardiovascular Medicine


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