Precision in Practice: Assessing Concordance between Physician Visual Assessment and Quantitative Coronary Analysis for Stenosis Severity in CAD Patients at Shifa International Hospital

Abstract

Background: Coronary Artery Disease (CAD) is a leading cause of mortality globally, necessitating accurate assessment of stenosis severity for optimal clinical management. Physician Visual Assessment (PVA) is commonly used in practice, but its subjective nature raises concerns about accuracy. Quantitative Coronary Analysis (QCA) offers a more objective method for evaluating stenosis severity. This study investigates the concordance between PVA and QCA in determining stenosis severity among CAD patients at Shifa International Hospital.

Objective: To evaluate the level of concordance between Physician Visual Assessment (PVA) and Quantitative Coronary Analysis (QCA) in assessing the severity of coronary artery stenosis in patients with CAD.

Methods: This retrospective cross-sectional study was conducted at the Cardiac Catheterization Department of Shifa International Hospital over a two-month period. A total of 105 CAD patients undergoing PCI were included. Lesions were evaluated by PVA during coronary angiography and subsequently assessed by QCA using Siemens Artis Zee software. The lesions were categorized into four severity groups: <50%, 50-69%, 70-89%, and 90-99%. Concordance between PVA and QCA was analyzed using independent sample t-tests with a 95% confidence level, and results were processed using SPSS version 25. Ethical approval was obtained from the Institutional Review Board (IRB) of Shifa International Hospital.

Results: The study population comprised 77% males and 23% females, with the majority aged between 51-70 years. The <50% stenosis category showed significant differences between PVA and QCA, with mean stenosis values of 34.66% (SD = 6.7) for PVA and 42.22% (SD = 7.3) for QCA (p < 0.001). Similarly, in the 50-69% category, the mean stenosis values were 56.83% (SD = 6.2) for PVA and 63.79% (SD = 4.5) for QCA (p < 0.001). However, in the 70-89% and 90-99% categories, the mean differences were not statistically significant, with p-values of 0.36 and 0.21, respectively.

Conclusion: The study revealed low concordance between PVA and QCA in the <50% and 50-69% stenosis categories, suggesting that visual assessment alone may not be sufficient for accurate evaluation in these cases. QCA should be utilized alongside PVA to enhance diagnostic accuracy and improve treatment decisions, particularly for mild to moderate stenosis.