Key result
Cardiologists show poor agreement classifying PCI complexity and fair agreement assessing procedural risk.
Why the study?
Despite several definitions of complex PCI, it is unclear whether cardiologists agree in classifying case complexity, which can lead to significant variation in clinical decision-making.
Is there agreement among interventional cardiologists in defining the complexity and risk of PCI procedures?
Cross-Sectional (n=215)
Is there agreement among interventional cardiologists in defining the complexity and risk of PCI procedures?
The poor consensus among interventional cardiologists in defining complex PCI highlights the need for standardized criteria to ensure uniform clinical decision-making and optimal patient management.
Answers are grounded in this paper and cite their sources.
Variability in PCI complexity classification may affect case selection; leaves open standardized criteria for consistent research and decisions.
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.
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Rjoob et al. (2023) conducted a cross-sectional in Interventional cardiologists' assessment of complex PCI (n=215). Assessment of clinical vignettes to classify PCI complexity was evaluated on Inter-rater agreement in classifying the complexity level of PCI (k = 0.1). There was poor inter-rater agreement among cardiologists in classifying the complexity level of PCI cases (k = 0.1) and fair agreement in classifying risk (k = 0.31).
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