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Testing common after PCI in older patients
A descriptive analysis found that noninvasive stress testing and invasive coronary angiography were used in nearly 60% of older patients after undergoing PCI.
Researchers of the study appearing in Circulation: Cardiovascular Imaging linked National Cardiovascular Data Registry CathPCI Registry data to longitudinal Medicare claims data for 250,350 patients undergoing PCI from 2005 to 2007. After linking them to subsequent testing and outcomes, researchers found that between 60 days post-PCI and 24 months of follow-up, 49% (n=122,894) received noninvasive stress tests, 10% (n=25,512) underwent invasive coronary angiography and 41% (n=101,944) had no testing.
Clinical risk factors at time of PCI were associated with less likelihood of stress testing or coronary angiography, including older age (HR=0.784 per 10-year increase), male sex (HR=0.946), HF (HR=0.925), diabetes mellitus (HR=0.954), smoking (HR=0.804) and renal failure (HR=0.88; P<.05 for all).
In addition, 15% of patients who underwent a stress test then had coronary angiography within 90 days of testing (n=18,472/101,884). Of those who underwent a stress test first, 48% (n=8,831) underwent revascularization within 90 days compared with 53% (n=13,316) of patients who underwent coronary angiography first (P<.0001).
Researchers wrote that the observations, from this and other studies, suggest that there may be opportunities to improve the selection of patients for stress testing and coronary angiography after PCI.
“During the time period studied, we did see a modest but significant decline in testing rates after PCI driven by declines in [stress testing] rates, especially nuclear [stress tests],” they wrote. “This finding is consistent with reports of slowing growth in the setting of decreasing reimbursement rates following passage of the Deficit Reduction Act of 2005, the introduction of the American College of Cardiology Appropriate Use Criteria standards, and a growing focus on ensuring appropriate indications for testing during the years of the study period.”
Disclosure: The researchers report no relevant financial disclosures.