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European Heart Journal 1994 15(6):815-822;
Copyright © 1994 by the European Society of Cardiology.
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© 1994 The European Society of Cardiology

The ‘Ermenonville’ classification of observations at coronary angioscopy—evaluation of intra- and inter-observer agreement

P. DEN HEIJER*,, D. P. FOLEY{dagger}, H. L. HILLEGE*, J. M. LABLANCHE{ddagger}, R. B. VAN DIJK*, D. FRANZEN§, M. C. MORICE||, A. SERRA, I. K. DE SCHEERDER**, P. W. SERRUYS{dagger} and K. I. LIE*

ON BEHALF OF THE EUROPEAN WORKING GROUP ON CORONARY ANGIOSCOPY
*Thoraxcenter, University Hospital Groningen The Netherlands
{dagger}Thoraxcenter, Erasmus University Rotterdam, The Netherlands
{ddagger}Hopital Cardiologique Lille, France
§Universitäts Klinikum Köln, Germany
||C.N.N Paris, Centre de Cardiologie du Nord Saint-Denis, France
Hospital Clinic I Provincial de Barcelona Barcelona, Spain
**U.Z. Gasthuisberg Leuven, Belgium

Received 27 September 1993; revised 20 January 1994; .

Correspondence. Peter den Heijer, MD, Department of Cardiology, Thorax center, University Hospital, Oostersingel 59, 9713 EZ Groningen, The Netherlands.

Abstract

A European coronary angioscopy working group has been established to create and evaluate a classification system for angioscopic observation. The ‘Ermenonville’ classification features items, graded in 3–5 categories, such as lumen diameter, shape of narrowing, colours of surface, atheroma, dissection, thrombus, etc. Inter- and intra-observer agreement on the interpretation of angioscopic images, using this classification system, was studied within the working group. Kappa values for chance-corrected intra-observer agreement of the diagnostic items were 0.51–0.67. The mean kappa values for inter-observer agreement were very low at 0.13–0.29. The important items, such as red thrombus and dissection were studied after recoding as either present or absent. These items proved to have a good intra-observer agreement, and an acceptable inter-observer agreement after recoding. Other angioscopic diagnoses should be made with caution. Multicentre angioscopy studies should make use of an angioscopy core laboratory. A set of definitions for coronary angioscopy is proposed, and this working group will re-evaluate observer agreements using these definitions.

Key Words: Angioscopy • coronary artery disease • coronary angioplasty • PTCA • intra-observer agreement • inter-observer agreement


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