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Original research article
Observer variability in the assessment of CT coronary angiography and coronary artery calcium score: substudy of the Scottish COmputed Tomography of the HEART (SCOT-HEART) trial
  1. Michelle C Williams1,
  2. Saroj K Golay1,
  3. Amanda Hunter1,
  4. Jonathan R Weir-McCall2,
  5. Lucja Mlynska1,
  6. Marc R Dweck1,3,
  7. Neal G Uren3,
  8. John H Reid4,
  9. Steff C Lewis5,
  10. Colin Berry6,
  11. Edwin J R van Beek1,7,
  12. Giles Roditi8,
  13. David E Newby1,3,7 and
  14. Saeed Mirsadraee7
  15. On behalf of the SCOTHEART Investigators
  1. 1University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Lothian, UK
  2. 2Division of Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, UK
  3. 3Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
  4. 4Borders General Hospital, Melrose, UK
  5. 5Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
  6. 6British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
  7. 7Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK
  8. 8Department of Radiology, Glasgow Royal Infirmary, Glasgow, UK
  1. Correspondence to Dr Michelle C Williams; michelle.williams{at}


Introduction Observer variability can influence the assessment of CT coronary angiography (CTCA) and the subsequent diagnosis of angina pectoris due to coronary heart disease.

Methods We assessed 210 CTCAs from the Scottish COmputed Tomography of the HEART (SCOT-HEART) trial for intraobserver and interobserver variability. Calcium score, coronary angiography and image quality were evaluated. Coronary artery disease was defined as none (<10%), mild (10–49%), moderate (50–70%) and severe (>70%) luminal stenosis and classified as no (<10%), non-obstructive (10–70%) or obstructive (>70%) coronary artery disease. Post-CTCA diagnosis of angina pectoris due to coronary heart disease was classified as yes, probable, unlikely or no.

Results Patients had a mean body mass index of 29 (28, 30) kg/m2, heart rate of 58 (57, 60)/min and 62% were men. Intraobserver and interobserver agreements for the presence or absence of coronary artery disease were excellent (95% agreement, κ 0.884 (0.817 to 0.951) and good (91%, 0.791 (0.703 to 0.879)). Intraobserver and interobserver agreement for the presence or absence of angina pectoris due to coronary heart disease were excellent (93%, 0.842 (0.918 to 0.755) and good (86%, 0.701 (0.799 to 0.603)), respectively. Observer variability of calcium score was excellent for calcium scores below 1000. More segments were categorised as uninterpretable with 64-multidetector compared to 320-multidetector CTCA (10.1% vs 2.6%, p<0.001) but there was no difference in observer variability.

Conclusions Multicentre multidetector CTCA has excellent agreement in patients under investigation for suspected angina due to coronary heart disease.

Trial registration number NCT01149590.


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