Koutsoukis Athanasios, Halna du Fretay Xavier, Dupouy Patrick, Ou Phalla, Laissy Jean-Pierre, Juliard Jean-Michel, Hyafil Fabien, Aubry Pierre
Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
Department of Cardiology, Foch Hospital, Suresnes, France.
Congenit Heart Dis. 2017 Dec;12(6):726-732. doi: 10.1111/chd.12504. Epub 2017 Jun 21.
The diagnosis of anomalous connections of the coronary arteries (ANOCOR) requires an appropriate identification for the management of the patients involved. We studied the observer variability in the description and classification of ANOCOR between a nonexpert group of physicians and a group of expert physicians, using the ANOCOR cohort.
Consecutive patients identified by 71 referring cardiologists were included in the ANOCOR cohort. Anomalous connection was diagnosed by invasive and/or computed tomography coronary angiography. Angiographic images were reviewed by an angiographic committee with experience in this field. Both investigators and angiographic committee filled out a questionnaire to classify each anomaly with the type of coronary artery involved, the site of anomalous connection, and the initial course. Observer variability between investigators and angiographic committee was assessed by κ statistics. Anomalous connection with a preaortic course was defined as at-risk.
Among 472 patients of the ANOCOR cohort, 496 abnormalities were identified with a preaortic course present in 31%. The agreement for the type of artery was excellent (κ = 0.92, 95% CI = 0.86-0.98, P < .05), while the agreement for the site of anomalous connection was moderate (κ = 0.50, 95% CI = 0.42-0.58, P < .05), and the agreement for the initial course was only fair (κ = 0.32, 95% CI = 0.28-0.37, P < .05). Observer agreement for the identification of at-risk forms was moderate (κ = 0.497, 95% CI = 0.40-0.59, P < .05).
Observer variability in the assessment of anomalous connection of the coronary arteries between nonexperienced and experienced physicians can be significant. We found that expert physicians provide a more robust classification in comparison with nonexpert physicians. Therefore, referral to physicians with a relevant experience should be considered, especially if an anomaly at-risk is suspected.
冠状动脉异常连接（ANOCOR）的诊断需要进行适当识别，以便对相关患者进行管理。我们使用ANOCOR队列研究了非专家医师组和专家医师组在ANOCOR描述和分类方面的观察者变异性。
71位转诊心脏病专家确定的连续患者被纳入ANOCOR队列。通过侵入性和/或计算机断层扫描冠状动脉造影诊断异常连接。血管造影图像由该领域有经验的血管造影委员会进行审查。研究人员和血管造影委员会都填写了一份问卷，以根据受累冠状动脉类型、异常连接部位和初始走行对每种异常进行分类。通过κ统计评估研究人员与血管造影委员会之间的观察者变异性。主动脉前走行的异常连接被定义为有风险。
在ANOCOR队列的472例患者中，共识别出496处异常，其中31%存在主动脉前走行。动脉类型的一致性极佳（κ = 0.92，95%CI = 0.86 - 0.98，P <.05），而异常连接部位的一致性中等（κ = 0.50，95%CI = 0.42 - 0.58，P <.05），初始走行的一致性仅为一般（κ = 0.32，95%CI = 0.28 - 0.37，P <.）。识别有风险形式的观察者一致性中等（κ = 0.497，95%CI = 0.40 - 0.59，P <.05）。
经验不足和经验丰富的医师在评估冠状动脉异常连接时，观察者变异性可能很大。我们发现，与非专家医师相比，专家医师能提供更可靠的分类。因此，应考虑转诊给有相关经验的医师，尤其是怀疑存在有风险异常的情况。
