title: Factors Associated With Errors in Visual Estimation of the Functional Significance of Coronary Lesions.
abstract: INTRODUCTION AND
  
  
  OBJECTIVE
  Visual angiographic assessment continues to be used when decisions are made on whether to revascularize ambiguous coronary lesions. Multiple factors, other than the degree of stenosis, have been associated with the functional significance of a coronary lesion. The aim of this study was to investigate the ability of interventionists to visually predict the functional significance of a coronary lesion and the clinical and angiographic characteristics associated with errors in prediction.
  
  
  METHODS
  We conducted a concordance study of the functional significance of coronary lesions predicted by experienced interventionists and fractional flow reserve values measured by intracoronary pressure wire in 665 intermediate lesions (40%-70% diameter stenosis) in 587 patients. We determined which factors were independently associated with errors in prediction.
  
  
  RESULTS
  There was disagreement between the predicted fractional flow reserve value of ≤ 0.80 and the observed value in 30.1% of the lesions (overestimation: 11.3%; underestimation, 18.8%). Stent location in an artery other than the anterior descending artery or in a bifurcation was associated with overestimation. Male sex, severe calcification, and a greater myocardial territory distal to the lesion were significantly associated with the functional significance of the underestimated lesion.
  
  
  CONCLUSIONS
  Even when taking into account angiographic and clinical characteristics, there is a high rate of disagreement between visual estimation and direct measurement of intermediate coronary stenosis in relation to its functional significance. Specific angiographic and clinical characteristics are associated with an increased tendency to overestimate or underestimate the significance of lesions.
authors.affiliation: Unidad de Hemodinámica, Sección de Cardiología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain. Electronic address: ramonlopezpalop@gmail.com.
authors.forename: Ramón
authors.initials: R
authors.lastname: López-Palop
authors.affiliation: Unidad de Hemodinámica, Sección de Cardiología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Carrillo
authors.affiliation: Unidad de Hemodinámica, Sección de Cardiología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Agudo
authors.affiliation: Unidad de Hemodinámica, Sección de Cardiología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cordero
authors.affiliation: Unidad de Hemodinámica, Sección de Cardiología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain.
authors.forename: Araceli
authors.initials: A
authors.lastname: Frutos
authors.affiliation: Unidad de Hemodinámica, Sección de Cardiología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain.
authors.forename: Samer
authors.initials: S
authors.lastname: Mashlab
authors.affiliation: Unidad de Hemodinámica, Sección de Cardiología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain.
authors.forename: Rubén
authors.initials: R
authors.lastname: Martínez
authors.affiliation: Unidad de Hemodinámica, Sección de Cardiología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain.
authors.forename: Amin
authors.initials: A
authors.lastname: El Amrani
authors.affiliation: Unidad de Hemodinámica, Sección de Cardiología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Ramos
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003951:Diagnostic Errors; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Angiografía coronaria; Angioplastia coronaria; Coronary angiography; Coronary angioplasty; Coronary heart disease; Enfermedad coronaria; Fractional flow reserve; Reserva fraccional de flujo