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Influence of coronary anatomy and SYNTAX score on the variations in revascularization strategies for patients with multi-vessel disease


Background — The Variation in Revascularization Practice in Ontario (VRPO) project helped describe variations in revascularization across Ontario. Coronary anatomy was the most important predictor of revascularization strategy. The authors conducted a novel angiographic sub-study of the VRPO cohort, to (1) validate “real-world” coronary angiographic reporting in the province of Ontario and (2) understand the relationship between variability in revascularization and coronary anatomy complexity.

Methods — 1787 angiograms from 17 cardiac centres were randomly sampled from the VRPO cohort. The core-lab assessment involved blinded interpretation of each angiographic film. A comparison of agreement in coronary anatomy and treatment strategy between abstracted chart data from the VRPO study and blinded film review was undertaken. SYNTAX scores were calculated for all patients with multi-vessel disease.

Results — The weighted kappa statistic for coronary anatomy was 0.75 (95% CI 0.72-0.77), suggesting substantial agreement between abstracted chart data and blinded film review. The weighted kappa for revascularization strategy was 0.51 (95% CI 0.47-0.54) suggesting only moderate agreement. There were no significant differences in the mean/median SYNTAX scores across all 4 PCI: CABG groups.

Conclusion — Abstracted chart data in the VRPO project provides a valid assessment of coronary anatomy and furthermore serves as validation of “real-world” coronary angiographic reporting in the province of Ontario. The uniform distribution of coronary complexity across centres in Ontario, with respect to the SYNTAX score, suggests the variation of PCI:CABG ratio is not related to a difference in coronary anatomy complexity across sites, but rather a difference in management strategies for the same anatomy.



Schwalm JD, Wijeysundera HC, Tu JV, Guo H, Kingsbury K, Natarajan MK. Can J Cardiol. 2014; 30(10):1155-61. Epub 2014 Apr 14.

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