Richard A. Chazal

Comparison of Clinical Interpretation with Visual Assessment and Quantitative Coronary Angiography in Patients Undergoing Percutaneous Coronary Intervention in Contemporary Practice: The Assessing Angiography (A2) Project

Background— Studies conducted decades ago described substantial disagreement and errors in physicians’ angiographic interpretation of coronary stenosis severity. Despite the potential implications of such findings, no large-scale efforts to measure or improve clinical interpretation were subsequently undertaken. Methods and Results— We compared clinical interpretation of stenosis severity in coronary lesions with an independent assessment using quantitative coronary angiography (QCA) in 175 randomly selected patients undergoing elective percutaneous coronary intervention at 7 US hospitals in 2011. To assess agreement, we calculated mean difference in percent diameter stenosis between clinical interpretation and QCA and a Cohen weighted &kgr; statistic. Of 216 treated lesions, median percent diameter stenosis was 80.0% (quartiles 1 and 3, 80.0% and 90.0%), with 213 (98.6%) assessed as ≥70%. Mean difference in percent diameter stenosis between clinical interpretation and QCA was 8.2±8.4%, reflecting an average higher percent diameter stenosis by clinical interpretation (P<0.001). A weighted &kgr; of 0.27 (95% confidence interval, 0.18–0.36) was found between the 2 measurements. Of 213 lesions considered ≥70% by clinical interpretation, 56 (26.3%) were <70% by QCA, although none were <50%. Differences between the 2 measurements were largest for intermediate lesions by QCA (50% to <70%), with variation existing across sites. Conclusions— Physicians tended to assess coronary lesions treated with percutaneous coronary intervention as more severe than measurements by QCA. Almost all treated lesions were ≥70% by clinical interpretation, whereas approximately one quarter were <70% by QCA. These findings suggest opportunities to improve clinical interpretation of coronary angiography.

ABIM Maintenance of Certification: Current Status

![Figure][1] The American Board of Internal Medicine’s (ABIM’s) Maintenance of Certification (MOC) process continues to be a topic of high interest for members of the American College of Cardiology (ACC). On 2 prior occasions, JACC Leadership Pages have been used to provide the ACC

Reading the Tea Leaves: Where Will Cardiology Be in 2050?

![Figure][1] During a period of rapid change, all of us are trying to emulate “The Great One” in “skating to the puck” [(1)][2]. Few areas of life are likely to change as much as medicine in general—and cardiovascular medicine in particular. The ability to identify meaningful

President's Page: ACC Strategic Planning to Improve Value for Patients and Members

![Figure][1] ![Figure][1] ![Figure][1] “You have to be fast on your feet and adaptive or else a strategy is useless” –Charles de Gaulle [(1)][2] As the American College of Cardiology (ACC) prepares to celebrate its 65th anniversary, opportunities abound for the College

Diversifying Our Ranks: A Call to Action

![Figure][1] ![Figure][1] Addressing disparities in care and ensuring the ultimate well-being of patients has been a priority throughout our careers, and is a key focus of this year as president and president-elect of the American College of Cardiology (ACC). Doing this successfully

Preparing for a Value-Based Health Care System.

![Figure][1] ![Figure][1] ![Figure][1] Over the last several years, health care reform efforts have compelled us to rethink how we deliver care. Economic pressures related to health care costs [(1)][2], concerns about quality, evolving medical technology, and improvements in

Updated Clinical Practice Guidelines on Heart Failure

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American College of Cardiology and American Heart Association: Setting a New Standard for Hospital Accreditation—Together

In today’s healthcare environment, terms such as value-based, transparent, efficient, evidence-based, accountable, and cost-effective are used frequently when talking about new care delivery models and models of physician and hospital reimbursement. Within the context of this environment, accreditation is increasingly being looked to as a means of helping hospitals and physicians successfully prepare for and participate in these new models. “Organizations that participate in accreditation confirm their commitment to quality improvement, risk mitigation, patient safety, improved efficiency, and accountability; it sends a powerful message to key decision-makers and the public. This performance measure contributes to the sustainability of the health care system,” wrote Wendy Nicklin, president and chief executive officer of Accreditation Canada, in an updated 2015 review of scholarly papers related to hospital accreditation.1 In a 2010 Presidential Advisory, the American Heart Association (AHA) identified the need, opportunity, and responsibility for the cardiovascular community to provide greater leadership in the design, development, and offering of accreditation services with the potential to provide clinical care. As stated in …

Comparison of Clinical Interpretation With Visual Assessment and Quantitative Coronary Angiography in Patients Undergoing Percutaneous Coronary Intervention in Contemporary Practice

Background— Studies conducted decades ago described substantial disagreement and errors in physicians’ angiographic interpretation of coronary stenosis severity. Despite the potential implications of such findings, no large-scale efforts to measure or improve clinical interpretation were subsequently undertaken. Methods and Results— We compared clinical interpretation of stenosis severity in coronary lesions with an independent assessment using quantitative coronary angiography (QCA) in 175 randomly selected patients undergoing elective percutaneous coronary intervention at 7 US hospitals in 2011. To assess agreement, we calculated mean difference in percent diameter stenosis between clinical interpretation and QCA and a Cohen weighted &kgr; statistic. Of 216 treated lesions, median percent diameter stenosis was 80.0% (quartiles 1 and 3, 80.0% and 90.0%), with 213 (98.6%) assessed as ≥70%. Mean difference in percent diameter stenosis between clinical interpretation and QCA was 8.2±8.4%, reflecting an average higher percent diameter stenosis by clinical interpretation (P<0.001). A weighted &kgr; of 0.27 (95% confidence interval, 0.18–0.36) was found between the 2 measurements. Of 213 lesions considered ≥70% by clinical interpretation, 56 (26.3%) were <70% by QCA, although none were <50%. Differences between the 2 measurements were largest for intermediate lesions by QCA (50% to <70%), with variation existing across sites. Conclusions— Physicians tended to assess coronary lesions treated with percutaneous coronary intervention as more severe than measurements by QCA. Almost all treated lesions were ≥70% by clinical interpretation, whereas approximately one quarter were <70% by QCA. These findings suggest opportunities to improve clinical interpretation of coronary angiography.

A Call to Action in Changing Times.

![Figure][1] “These are changing times!” is an overused cliche, especially in a major election year, but is perhaps more germane now than ever in the health care arena, particularly the field of cardiac care. Advances in diagnostics and therapeutics are being made at a rapid pace,