SYNTAX score reproducibility and variability between interventional cardiologists, core laboratory technicians, and quantitative coronary measurements

Philippe Genereux, Tullio Palmerini, Adriano Caixeta, Ecaterina Cristea, Roxana Mehran, Raquel Sanchez, Dana Lazar, Ivana Jankovic, Maria D. Corral, Ovidiu Dressler, Martin P. Fahy, Helen Parise, Alexandra J. Lansky, Gregg W. Stone

Research output: Contribution to journalArticle

82 Citations (Scopus)

Abstract

Background-In the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial, the SYNTAX score was useful in risk stratifying patients with complex coronary artery disease. The reproducibility of this score may affect its clinical utility. We therefore assessed SYNTAX score interobserver and intraobserver variability among a group of interventional cardiologists (ICs) and an experienced group of angiographic core laboratory (ACL) technicians. Methods and Results-After basic training from the SYNTAX score website, 3 ICs and 4 ACL technicians, each working independently, assessed the SYNTAX score of 30 multivessel disease angiograms. The ICs then underwent an intensive training session with ACL technicians, after which the SYNTAX score from 50 additional angiograms were assessed independently by both groups. Interobserver Fleiss κ statistic values were determined. A third assessment was performed using quantitative coronary angiography (QCA). The ACL technician interobserver strength of agreement from both periods was substantial or greater (k=0.82; 95% CI [0.72, 1.00] and 0.84 [0.76, 1.00]) and not different than QCA. The IC interobserver agreement was initially estimated to be at least slight (k=0.33 [0.18, 0.44]), improving to substantial or greater after advanced training (k=0.76 [0.64, 1.00]). Despite advanced training, ICs underscored the number of lesions, bifurcations, and small-vessel disease (P=0.001), resulting in a lower score than ACL technicians (mean difference=7.5, P<0.001). Conclusions-Highly reproducible SYNTAX score measurements were quickly achieved by experienced ACL technicians. In contrast, agreement among ICs after the basic tutorial was initially poor but improved considerably after further training with the ACL, although differences still remained in interpretation of several lesion types. These findings have important implications for adoption of SYNTAX score methodology in routine practice and future clinical trials.

Original languageEnglish (US)
Pages (from-to)553-561
Number of pages9
JournalCirculation: Cardiovascular Interventions
Volume4
Issue number6
DOIs
StatePublished - Dec 1 2011
Externally publishedYes

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Laboratory Personnel
Coronary Angiography
Angiography
Taxus
Observer Variation
Percutaneous Coronary Intervention
Thoracic Surgery
Cardiologists
Coronary Artery Disease
Clinical Trials

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Genereux, Philippe ; Palmerini, Tullio ; Caixeta, Adriano ; Cristea, Ecaterina ; Mehran, Roxana ; Sanchez, Raquel ; Lazar, Dana ; Jankovic, Ivana ; Corral, Maria D. ; Dressler, Ovidiu ; Fahy, Martin P. ; Parise, Helen ; Lansky, Alexandra J. ; Stone, Gregg W. / SYNTAX score reproducibility and variability between interventional cardiologists, core laboratory technicians, and quantitative coronary measurements. In: Circulation: Cardiovascular Interventions. 2011 ; Vol. 4, No. 6. pp. 553-561.
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abstract = "Background-In the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial, the SYNTAX score was useful in risk stratifying patients with complex coronary artery disease. The reproducibility of this score may affect its clinical utility. We therefore assessed SYNTAX score interobserver and intraobserver variability among a group of interventional cardiologists (ICs) and an experienced group of angiographic core laboratory (ACL) technicians. Methods and Results-After basic training from the SYNTAX score website, 3 ICs and 4 ACL technicians, each working independently, assessed the SYNTAX score of 30 multivessel disease angiograms. The ICs then underwent an intensive training session with ACL technicians, after which the SYNTAX score from 50 additional angiograms were assessed independently by both groups. Interobserver Fleiss κ statistic values were determined. A third assessment was performed using quantitative coronary angiography (QCA). The ACL technician interobserver strength of agreement from both periods was substantial or greater (k=0.82; 95{\%} CI [0.72, 1.00] and 0.84 [0.76, 1.00]) and not different than QCA. The IC interobserver agreement was initially estimated to be at least slight (k=0.33 [0.18, 0.44]), improving to substantial or greater after advanced training (k=0.76 [0.64, 1.00]). Despite advanced training, ICs underscored the number of lesions, bifurcations, and small-vessel disease (P=0.001), resulting in a lower score than ACL technicians (mean difference=7.5, P<0.001). Conclusions-Highly reproducible SYNTAX score measurements were quickly achieved by experienced ACL technicians. In contrast, agreement among ICs after the basic tutorial was initially poor but improved considerably after further training with the ACL, although differences still remained in interpretation of several lesion types. These findings have important implications for adoption of SYNTAX score methodology in routine practice and future clinical trials.",
author = "Philippe Genereux and Tullio Palmerini and Adriano Caixeta and Ecaterina Cristea and Roxana Mehran and Raquel Sanchez and Dana Lazar and Ivana Jankovic and Corral, {Maria D.} and Ovidiu Dressler and Fahy, {Martin P.} and Helen Parise and Lansky, {Alexandra J.} and Stone, {Gregg W.}",
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Genereux, P, Palmerini, T, Caixeta, A, Cristea, E, Mehran, R, Sanchez, R, Lazar, D, Jankovic, I, Corral, MD, Dressler, O, Fahy, MP, Parise, H, Lansky, AJ & Stone, GW 2011, 'SYNTAX score reproducibility and variability between interventional cardiologists, core laboratory technicians, and quantitative coronary measurements', Circulation: Cardiovascular Interventions, vol. 4, no. 6, pp. 553-561. https://doi.org/10.1161/CIRCINTERVENTIONS.111.961862

SYNTAX score reproducibility and variability between interventional cardiologists, core laboratory technicians, and quantitative coronary measurements. / Genereux, Philippe; Palmerini, Tullio; Caixeta, Adriano; Cristea, Ecaterina; Mehran, Roxana; Sanchez, Raquel; Lazar, Dana; Jankovic, Ivana; Corral, Maria D.; Dressler, Ovidiu; Fahy, Martin P.; Parise, Helen; Lansky, Alexandra J.; Stone, Gregg W.

In: Circulation: Cardiovascular Interventions, Vol. 4, No. 6, 01.12.2011, p. 553-561.

Research output: Contribution to journalArticle

TY - JOUR

T1 - SYNTAX score reproducibility and variability between interventional cardiologists, core laboratory technicians, and quantitative coronary measurements

AU - Genereux, Philippe

AU - Palmerini, Tullio

AU - Caixeta, Adriano

AU - Cristea, Ecaterina

AU - Mehran, Roxana

AU - Sanchez, Raquel

AU - Lazar, Dana

AU - Jankovic, Ivana

AU - Corral, Maria D.

AU - Dressler, Ovidiu

AU - Fahy, Martin P.

AU - Parise, Helen

AU - Lansky, Alexandra J.

AU - Stone, Gregg W.

PY - 2011/12/1

Y1 - 2011/12/1

N2 - Background-In the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial, the SYNTAX score was useful in risk stratifying patients with complex coronary artery disease. The reproducibility of this score may affect its clinical utility. We therefore assessed SYNTAX score interobserver and intraobserver variability among a group of interventional cardiologists (ICs) and an experienced group of angiographic core laboratory (ACL) technicians. Methods and Results-After basic training from the SYNTAX score website, 3 ICs and 4 ACL technicians, each working independently, assessed the SYNTAX score of 30 multivessel disease angiograms. The ICs then underwent an intensive training session with ACL technicians, after which the SYNTAX score from 50 additional angiograms were assessed independently by both groups. Interobserver Fleiss κ statistic values were determined. A third assessment was performed using quantitative coronary angiography (QCA). The ACL technician interobserver strength of agreement from both periods was substantial or greater (k=0.82; 95% CI [0.72, 1.00] and 0.84 [0.76, 1.00]) and not different than QCA. The IC interobserver agreement was initially estimated to be at least slight (k=0.33 [0.18, 0.44]), improving to substantial or greater after advanced training (k=0.76 [0.64, 1.00]). Despite advanced training, ICs underscored the number of lesions, bifurcations, and small-vessel disease (P=0.001), resulting in a lower score than ACL technicians (mean difference=7.5, P<0.001). Conclusions-Highly reproducible SYNTAX score measurements were quickly achieved by experienced ACL technicians. In contrast, agreement among ICs after the basic tutorial was initially poor but improved considerably after further training with the ACL, although differences still remained in interpretation of several lesion types. These findings have important implications for adoption of SYNTAX score methodology in routine practice and future clinical trials.

AB - Background-In the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial, the SYNTAX score was useful in risk stratifying patients with complex coronary artery disease. The reproducibility of this score may affect its clinical utility. We therefore assessed SYNTAX score interobserver and intraobserver variability among a group of interventional cardiologists (ICs) and an experienced group of angiographic core laboratory (ACL) technicians. Methods and Results-After basic training from the SYNTAX score website, 3 ICs and 4 ACL technicians, each working independently, assessed the SYNTAX score of 30 multivessel disease angiograms. The ICs then underwent an intensive training session with ACL technicians, after which the SYNTAX score from 50 additional angiograms were assessed independently by both groups. Interobserver Fleiss κ statistic values were determined. A third assessment was performed using quantitative coronary angiography (QCA). The ACL technician interobserver strength of agreement from both periods was substantial or greater (k=0.82; 95% CI [0.72, 1.00] and 0.84 [0.76, 1.00]) and not different than QCA. The IC interobserver agreement was initially estimated to be at least slight (k=0.33 [0.18, 0.44]), improving to substantial or greater after advanced training (k=0.76 [0.64, 1.00]). Despite advanced training, ICs underscored the number of lesions, bifurcations, and small-vessel disease (P=0.001), resulting in a lower score than ACL technicians (mean difference=7.5, P<0.001). Conclusions-Highly reproducible SYNTAX score measurements were quickly achieved by experienced ACL technicians. In contrast, agreement among ICs after the basic tutorial was initially poor but improved considerably after further training with the ACL, although differences still remained in interpretation of several lesion types. These findings have important implications for adoption of SYNTAX score methodology in routine practice and future clinical trials.

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U2 - 10.1161/CIRCINTERVENTIONS.111.961862

DO - 10.1161/CIRCINTERVENTIONS.111.961862

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JF - Circulation: Cardiovascular Interventions

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