Coronary Artery DiseaseMagnitude and consequences of error in coronary angiography interpretation (the ACRE study)☆
Section snippets
Study group
Patients (n = 209) were randomly selected for inclusion in this study if they satisfied the following criteria: (1) coronary angiography performed between April 1996 and April 1997 at the London Chest Hospital, London, United Kingdom; (2) no previous revascularization (because the angiographic appearances in such patients might bias the reliability estimates); and (3) participation in the ACRE study (n = 4,121). The ACRE study is a prospective cohort of all patients who underwent coronary
Patient characteristics
The 209 patients had a mean age of 58 years (range 23 to 83) and 32% were women. Clinical presentations were chronic stable angina (44%), unstable angina (13%), myocardial infarction (16%), asymptomatic (10%), atypical chest pain (9%), and other (8%). Fifteen percent of patients were diabetic, 36% hypertensive, and 14% were current smokers. Only 11 patients (5%) had a Parsonnet score >18, indicating high operative risk. The sample was representative of the larger ACRE cohort in terms of age,
Discussion
This is the first study of interobserver variability in the interpretation of coronary angiography in routine clinical practice. There was a low magnitude of error (good agreement beyond chance) in the number of narrowed arteries recorded in the case notes compared with independent review by 2 cardiologists who were blinded to clinical details. We investigated the possible consequences of such error by comparing actual patient management with hypothetical management decisions, separately in
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The ACRE study was established with a grant from East London and the City Health Authority, and subsequently funded by a consortium of health authorities (North Essex, Barking and Havering, Redbridge and Waltham Forest), the North Thames NHS Research and Development program (RFG 258), and the British Heart Foundation (PG/97216), London, United Kingdom.