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Comparison of physician visual assessment with quantitative coronary angiography in assessment of stenosis severity in China

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作者：
Zhang, H[a] * ; Mu, L[b,c] ; Hu, S[a] ; Nallamothu, B.K[d] ; Lansky, A.J[e] ; Xu, B[a] ; Bouras, G[e] ; Cohen, D.J[f] ; Spertus, J.A[f] ; Masoudi, F.A[g] ; Curtis, J.P[b,c] ; Gao, R[a] ; Ge, J[h] ; Yang, Y[a] ; Li, J[a] ; Li, X[a] ; Zheng, X[a] ; Li, Y[a] ; Krumholz, H.M[b,c,i] ; Jiang, L[a] ; Wang, J[j] ; Zhang, H[j] ; Huang, C[j] ; Ma, L[k] ; Hu, H[k] ; Kong, X[k] ; Zhao, R[l] ; Du, W[l] ; Li, H[l] ; Yang, P[m] ; Feng, Z[m] ; Mao, C[m] ; Li, B[m] ; Han, Q[n] ; Duan, L[n] ; Jin, C[n] ; Guo, Y[o] ; Chen, X[o] ; Lin, F[o] ; Wu, Y[p] ; Tian, Y[p] ; Li, J[q] ; Zhu, C[q] ; Dong, Q[q] ; Pan, H[r] ; Gao, P[r] ; Sun, L[r] ; Zhang, W[s] ; Xie, S[s] ; Zhuang, Y[s] ; Li, W[s,ap] ; Ge, Z[t] ; Wen, H[t] ; Liu, Q[t] ; Li, Y[t] ; Han, Y[u] ; Zhao, P[u] ; Zhao, W[u] ; Hong, L[v] ; Li, L[v] ; Yuan, L[v] ; Li, Y[v] ; Zhao, P[w] ; Sun, J[w] ; Chai, R[w] ; Yang, S[x] ; Li, Y[x] ; Gao, J[x] ; Zhang, S[x] ; Yang, Y[y] ; Wu, G[y] ; Mao, J[y] ; Zheng, C[y] ; Bian, H[z] ; Chen, B[z] ; Cao, J[z] ; Yan, H[aa] ; Chen, L[aa] ; Liu, Q[aa] ; Chen, L[aa] ; Li, B[ab] ; Yang, B[ab] ; Li, J[ab] ; Wang, J[ab] ; Liu, F[ac] ; Meng, X[ac] ; Shao, B[ac] ; Liao, Z[ac] ; Liu, Z[ad] ; Jing, W[ad] ; Guo, Z[ad] ; Zhou, C[ae] ; Wang, Y[ae] ; Yu, T[ae] ; Li, D[af] ; Luo, Y[af] ; Zhu, H[af] ; Lin, J[ag] ; Chai, D[ag] ; Zhao, W[ag] ; Zheng, Y[ah] ; Liu, Z[ah] ; Zhou, W[ah] ; Zou, L[ah] ; Jin, Y[ai] ; Zhang, X[ai] ; Zhang, X[ai] ; Li, Z[aj] ; Liu, Y[aj] ; Yu, Q[aj] ; Xing, Y[aj] ; Wu, W[ak] ; Feng, J[ak] ; Fa, X[al] ; Zhang, L[al] ; Sun, L[al] ; Liu, L[al] ; Qu, P[am] ; Wang, H[am] ; Lou, D[am] ; Yuan, D[am] ; Wang, D[an] ; Shen, X[an] ; Jiang, J[an] ; Huang, H[ao] ; Zeng, J[ao] ; Wu, M[ao] ; Zhou, Y[ao] ; Zhang, H[ap] ; Jun, L[ap] ; Hu, M[ap] ; Zhang, L[aq] ; Guo, Y[aq] ; Sun, H[aq] ; for the China PEACE Collaborative Group ;
单位： [a]National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Division of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Rd, Beijing, 100037, China [b]Section of Cardiovascular Medicine, Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, United States [c]Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, United States [d]Ann Arbor VA Center for Clinical Management and Research, University of Michigan Health System, Ann Arbor, MI, United States [e]Yale University Medical Center, New Haven, CT, United States [f]Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, United States [g]Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States [h]Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China [i]Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, United States [j]Air Force General Hospital, United States [k]Anhui Provincial Hospital, United States [l]Baotou Central Hospital, United States [m]China-Japan Union Hospital, Jilin University, United States [n]First Hospital of Shanxi Medical University, United States [o]Fujian Provincial Hospital, United States [p]Fuwai Hospital, CAMSandPUMC (Ward 22), United States [q]Fuwai Hospital, CAMSandPUMC (Ward 25B), United States [r]General Hospital of China FAW Group Corporation, China [s]Guilin People's Hospital, China [t]Inner Mongolia Baogang Hopital, China [u]Inner Mongolia People's Hopsital, China [v]Jiangxi Provincial People's Hospital, China [w]Jinghai County Hospital, China [x]Nanyang Central Hospital, China [y]Qingdao Fuwai Hospital, China [z]Qinghai Cardiovascular and Cerebrovascular Hospital, China [aa]Qinzhou Second People's Hospital, China [ab]Shangxi Cardiovascular Hospital, China [ac]Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, China [ad]TEDA International Cardiovascular Hospital, China [ae]Affiliated Hospital of Qingdao University, China [af]Affiliated Hospital of Xuzhou Medical College, China [ag]First Affiliated Hospital, Fujian Medical University, China [ah]First Hospital of Jilin University, China [ai]Fourth Affiliated Hospital, China Medical University, China [aj]People's Hospital of Liaoning Province, China [ak]Second Affiliated Hospital, Xuzhou Medical College, China [al]Second Affiliated Hospital, Zhengzhou University, China [am]Second Hospital of Dalian Medical University, China [an]Tongji Hospital, Tongji Medical College, Huangzhong University of Science and Technology, China [ao]Xiangtan Central Hospital, China [ap]Xinqiao Hospital, Xuzhou First People's Hospital, China [aq]Zhengzhou Central Hospital, China
出处：
DOI： 10.1001/jamainternmed.2017.7821
ISSN：

摘要：
IMPORTANCE: Although physician visual assessment (PVA) of stenosis severity is a standard clinical practice to support decisions for coronary revascularization, there are concerns about its accuracy. OBJECTIVE: To compare PVA with quantitative coronary angiography (QCA) as a means of assessing stenosis severity among patients undergoing percutaneous coronary intervention (PCI) in China. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study (2012-2013) of a random subset of 1295 patients from the China Patient-centered Evaluative Assessment of Cardiac Events (PEACE) Prospective PCI Study was carried out. The PEACE Prospective PCI study recruited a consecutive sample of patients undergoing PCI at 35 hospitals in 18 provinces of China. The coronary angiograms of this subset of participants were reviewed using QCA by 2 independent core laboratories blinded to PVA readings. MAIN OUTCOMES AND MEASURES: Differences between PVA and QCA assessments of stenosis severity for lesions for which PCI was performed and variation of these differences among hospitals and physicians, stratified by the diagnosis of acutemyocardial infarction (AMI). RESULTS: In patients without AMI, the mean (SD) age was 62 (10) years, and 217 (31.5%) were women; in patients with AMI, the mean (SD) age was 60 (11) years, and 153 (25.2%) were women. The mean (SD) percent diameter stenosis by PVA was 16.0%(11.5%) greater than that by QCA in patients without AMI and 10.2%(12.3%) in those with AMI (P < .001 for both comparisons). In patients without AMI, of 837 lesions with 70%or more stenosis by PVA, 427 (50.6%) were less than 70%by QCA; in patients with AMI, similar patterns were observed to a lesser extent. Among patients without AMI, only 4 (0.47%) lesions were additionally assessed with fractional flow reserve. Among 30 hospitals, the difference between PVA and QCA readings of stenosis severity varied from 7.6%(95%CI, 0.4%-14.7%) to 21.3%(95%CI, 17.1%-24.9%) among non-AMI patients. Across 57 physicians, this difference varied from 6.9% (95%CI, -1.4%-15.3%) to 26.4%(95%CI, 21.5%-31.4%). CONCLUSIONS AND RELEVANCE: For coronary lesions treated with PCI in China, PVA reported substantially higher readings of stenosis severity than QCA, with large variation across hospitals and physicians. These findings highlight the need to improve the accuracy of information used to guide treatment decisions in catheterization laboratories. © 2018 American Medical Association. All rights reserved.

基金：
recipient of research agreements from Medtronic and from Johnson & Johnson (Janssen), through Yale University, to develop methods of clinical trial data sharing; is the recipient of a grant from the Food and Drug Administration and Medtronic to develop methods for postmarket surveillance of medical devices; works under contract with the Centers for Medicare & Medicaid Services to develop and maintain performance measures; chairs a cardiac scientific advisory board for UnitedHealth; is a participant/participant representative of the IBM Watson Health Life Sciences Board; and is the founder of Hugo, a personal health information platform. Dr Spertus is supported by grants from Gilead, Genentech, Lilly, Amorcyte, and EvaHeart, and has a patent for the Seattle Angina Questionnaire with royalties paid. Dr Masoudi has a contract with the American College of Cardiology for his role as the Chief Science Officer of the NCDR. Dr. Cohen receives research grant support from Medtronic, Boston Scientific, and Abbott Vascular, and consulting fees from Medtronic. No other disclosures are reported.
语种：
外文
PubmedID：
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出版当年[2017]版：
大类 | 1 区 医学
小类 | 1 区 医学：内科
最新[2025]版：
大类 | 1 区 医学
小类 | 1 区 医学：内科
第一作者：
第一作者单位： [a]National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Division of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Rd, Beijing, 100037, China
通讯作者：
推荐引用方式(GB/T 7714)：
Zhang H,Mu L,Hu S,et al.Comparison of physician visual assessment with quantitative coronary angiography in assessment of stenosis severity in China[J].JAMA internal medicine.2018,178(2):239-247.doi:10.1001/jamainternmed.2017.7821.
APA：
Zhang, H,Mu, L,Hu, S,Nallamothu, B.K,Lansky, A.J...&for the China PEACE Collaborative Group.(2018).Comparison of physician visual assessment with quantitative coronary angiography in assessment of stenosis severity in China.JAMA internal medicine,178,(2)
MLA：
Zhang, H,et al."Comparison of physician visual assessment with quantitative coronary angiography in assessment of stenosis severity in China".JAMA internal medicine 178..2(2018):239-247

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