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What is the inter-observer agreement in the angiographic determination of left main coronary artery stenosis?
What is the inter-observer agreement in the angiographic determination of left main coronary artery stenosis?
Angiographic assessment of left main coronary artery stenosis shows moderate agreement on exact severity but good agreement (80%) on whether stenosis is >50%, with short, diffusely diseased, or obscured segments being particularly difficult to interpret.
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Angiographic left main stenosis grading warrants clinical caution due to variability; leaves open need for standardized criteria or adjunctive imaging.
Reliability of angiographic assessment of the left main coronary artery segment was evaluated by review of 106 coronary cineangiograms from the Coronary Artery Surgery Study. The films were interpreted by three groups of angiographers: those at a clinical site, those at a quality control site, and those on a study census panel. Among the readings of these three groups, there was 41% to 59% agreement on the severity of the lesion, with 80% agreement on whether the lesion was greater or less than 50%. The severity of lesion, its location, or presence of ectasia or calcium did not affect the discrepancy rate, whereas segments that were unusually short, diffusely diseased, or obscured by overlapping vessels were especially difficult to interpret.
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Cameron et al. (1983) studied this question.
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