ArticleCirculation reports2025
Reproducibility, Accuracy, and Treatment Impact of Ischemia Severity Assessment From Coronary Angiography - An ORBITA Study Analysis.
Article in Circulation reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: This study aimed to assess the accuracy and intra-operator reproducibility of ischemia assessments from coronary angiography, as performed by interventional cardiologists, and its influence on treatment strategies. Methods and Results: Twenty-two interventionalists predicted fractional flow reserve (predFFR) from 194 angiograms obtained from patients with single-vessel disease in the Objective Randomized Blinded Investigation with Optimal Medical Therapy of Angioplasty in Stable Angina (ORBITA) study. For each case, respondents selected either angio-guided percutaneous coronary intervention (PCI), medication, or a physiology-guided approach. Respondents were divided into high- and low-physiology-use groups based on the frequency of selecting physiology-guided treatment. Physiological strategies were chosen for 60.3% and 23.9% of the cases in the high and low groups, respectively. Correlations between predFFR and measured FFR values were weak (r=0.451; P<0.001), with 84.7% agreement for fractional flow reserve ≤0.80 and 75.0% for severity classification. Intra-operator agreement for treatment strategy in duplicate cases was 76.9%. Bland-Altman analysis showed considerable variability in repeated predFFR estimations (limits of agreement -0.16 to +0.15), exceeding thresholds considered acceptable in clinical practice. Although the diagnostic concordance was similar, the low group made more inappropriate treatment decisions, notably selecting PCIs for non-ischemic lesions, and more often opted for medication in truly ischemic patients compared with the high group (P<0.001). Conclusions: Visual prediction of ischemia from angiography is limited in accuracy and reproducibility. Physiological assessment remains essential for determining the appropriate treatment.
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