Assessment, of coronary angioplasty: Comparison of visual assessment, hand‐held caliper measurement and automated digital quantitation

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Abstract
Digital subtraction coronary angiograms (DSA) of 27 patients who had undergone coronary angioplasty (PTCA) to a total of 32 lesions were analyzed using an automated border‐detecting computer program and hand‐held caliper measurement of diameter percent stenosis. The results were compared with visual interpretation of the 35‐mm cineangiograms. Visual reports significantly overestimated the pre‐PTCA diameter percent stenosis (P < .001) and underestimated the residual post‐PTCA narrowing compared with the automatic computer program (P < .001). Caliper measurements overestimated significantly the pre‐PTCA stenosis in comparison with the computer (P < .01), but post‐PTCA the two methods did not differ significantly (P = .105). There was a positive but poor correlation between caliper and computer measurements (r = .43, P < .05) performed on the pre‐PTCA digital angiograms. Post‐PTCA the two methods correlated better (r = 0.78, P < .001), but further statistical analysis showed important discrepancies between them. The correlation of visual reports and computer measurements was poor pre‐PTCA (Kendall's r = 0.32, P < .05) and not statistically significant post‐PTCA(r = 0.64, P = .5). We conclude that there is observer bias in the visual reporting of angioplasty results, so that pre‐PTCA lesions are overestimated, whereas post‐PTCA are underestimated. Hand‐held caliper measurement improves the assessment of coronary stenoses in comparison with the visual report but still may not altogether eliminate observer bias; it may overestimate the pre‐PTCA stenoses compared with automated border detection.

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