What are the limitations of coronary angiography?
Coronary angiography is not without limitations. First, the technical quality of angiograms in many settings can make accurate interpretation difficult or impossible. In a random sample of .300 coronary angiograms performed in New York State during the 1990s, 4% were of unacceptable quality, and 48% exhibited technical deficiencies that could interfere with accurate interpretation.369 Although more modern techniques and equipment likely have eliminated some of these deficiencies, few studies have addressed this issue, particularly in patients who present technical challenges, such as those who are obese. Second, problems also exist with interobserver reliability. These investigators also found only 70% overall agreement among readers with regard to the severity of stenosis, and this was reduced to 51% when restricted to coronary vessels rated as having some stenosis by any reader. 