Key result
Higher post-PCI diagnostic testing linked to ~20% higher repeat revascularization without reducing MI or death.
Why the study?
Little is known about patterns of diagnostic testing after PCI in the U.S. or the relationship of these patterns with clinical outcomes.
Does higher institutional use of diagnostic testing after PCI reduce the risk of acute myocardial infarction or death in older adults?
Cohort (n=247,052)
Yes
Does higher institutional use of diagnostic testing after PCI reduce the risk of acute myocardial infarction or death in older adults?
Effect estimate: 20% higher adjusted risk
p-value: p=<0.0001
Higher institutional rates of diagnostic testing after PCI are associated with increased rates of repeat revascularization but do not reduce the risk of myocardial infarction or death.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“One common assumption is that the way in which care is reimbursed leads to overuse. In this study we took reimbursement out of the equation, [but] we still see variation at the facility level that we don't quite understand.”
Higher post-PCI testing rates may increase revascularizations without reducing MI or death; leaves open optimal selective testing strategies in older adults.
Objectives To determine diagnostic testing patterns after percutaneous coronary intervention (PCI). Background Little is known about patterns of diagnostic testing after PCI in the U.S. or the relationship of these patterns with clinical outcomes. Methods We linked Centers for Medicare & Medicaid Services inpatient and outpatient claims to the National Cardiovascular Data Registry® CathPCI Registry® data from 2005–2007. Hospital quartiles of the cumulative incidence of diagnostic testing use within 12 and 24 months post-PCI were compared for patient characteristics, repeat revascularization, acute myocardial infarction (AMI), and death. Results A total of 247,052 patients underwent PCI at 656 institutions. Patient and site characteristics were similar across testing use quartiles. There was a 9% and 20% higher adjusted risk of repeat revascularization in Quartile 3 and Quartile 4 (highest testing rate), respectively, when compared to Quartile 1 (lowest testing rate) (p=0.020 and <0.0001, respectively). The adjusted risk for death or AMI did not differ among quartiles. Conclusions While patient characteristics were largely independent of rates of post-PCI testing, higher testing rates was not associated with lower risks of myocardial infarction or death, but repeat revascularization was significantly higher at these sites. Additional studies should examine whether increased testing is a marker for improved quality of post-PCI care or simply increased healthcare utilization.
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Shah et al. (2013) conducted a cohort in Post-percutaneous coronary intervention (PCI) with stenting (n=247,052). Higher rates of post-PCI diagnostic testing (Quartiles 3 and 4) vs. Lowest rates of post-PCI diagnostic testing (Quartile 1) was evaluated on Repeat revascularization (20% higher adjusted risk, p=<0.0001). Higher institutional rates of post-PCI diagnostic testing were associated with a 20% increased risk of repeat revascularization compared to the lowest testing rates, without reducing the risk of myocardial infarction or death.