What is the clinical evidence from this study?

Study design: Observational. Population: Coronary angioscopy observations. Intervention: 'Ermenonville' classification system. Primary outcome: Inter- and intra-observer agreement (Kappa values) (Kappa 0.51-0.67 (intra-observer); 0.13-0.29 (inter-observer)).

April 26, 2026

The ‘Ermenonville’ classification of observations at coronary angioscopy—evaluation of intra- and inter-observer agreement

Key Result

The 'Ermenonville' classification for coronary angioscopy showed intra-observer kappa values of 0.51-0.67 and very low inter-observer kappa values of 0.13-0.29.

Key Points

To create and assess the 'Ermenonville' classification system for angioscopic observation and its observer agreement.
Evaluation of inter- and intra-observer agreement using kappa statistics
Multicenter collaboration within a working group
Graded classification of angioscopic observation items
Intra-observer agreement kappa values ranged from 0.51 to 0.67
Inter-observer agreement kappa values were low, between 0.13 and 0.29
Significant agreement on critical items such as red thrombus and dissection after recoding.

Study Design

Type

Observational

Multicenter

Yes

Structured PICO

What is the intra- and inter-observer agreement of the 'Ermenonville' classification system for coronary angioscopy?

Population

European coronary angioscopy working group evaluating coronary angioscopy images

Intervention

The 'Ermenonville' classification system for angioscopic observation

Outcome

Intra- and inter-observer agreement (Kappa values) on the interpretation of angioscopic imagessurrogate

The 'Ermenonville' classification for coronary angioscopy has poor inter-observer agreement, highlighting the need for core laboratories in multicenter studies.

Main Result

Effect estimate: Kappa 0.51-0.67 (intra-observer); 0.13-0.29 (inter-observer)

Abstract

A European coronary angioscopy working group has been established to create and evaluate a classification system for angioscopic observation. The 'Ermenonville' classification features items, graded in 3-5 categories, such as lumen diameter, shape of narrowing, colours of surface, atheroma, dissection, thrombus, etc. Inter- and intra-observer agreement on the interpretation of angioscopic images, using this classification system, was studied within the working group. Kappa values for chance-corrected intra-observer agreement of the diagnostic items were 0.51-0.67. The mean kappa values for inter-observer agreement were very low at 0.13-0.29. The important items, such as red thrombus and dissection were studied after recoding as either present or absent. These items proved to have a good intra-observer agreement, and an acceptable inter-observer agreement after recoding. Other angioscopic diagnoses should be made with caution. Multicentre angioscopy studies should make use of an angioscopy core laboratory. A set of definitions for coronary angioscopy is proposed, and this working group will re-evaluate observer agreements using these definitions.