Key result
Cardiac stress testing was performed in 59.8% of patients within 2 years of PCI, with only 3.1% of tested patients undergoing repeat revascularization within 60 days.
Observational (n=112,691)
Yes
Despite appropriate use criteria recommending against routine stress testing after PCI, over half of patients undergo testing within 2 years, yielding a very low rate of subsequent revascularization.
High post-PCI stress testing rates yield low revascularization; challenges routine use in observational data but leaves optimal strategies open for RCTs.
BACKGROUND: The appropriate use criteria considers cardiac stress testing within 2 years after percutaneous coronary intervention (PCI) to be rarely appropriate, unless prompted by symptoms or change in clinical status. Little is known about the patterns of cardiac stress testing after PCI in the single-payer Canadian healthcare system, where mechanisms for reimbursement are different from the United States. METHODS AND RESULTS: Frequency and timing of cardiac stress testing within 2 years of PCI performed between April 2004 and March 2013 in Ontario, Canada, was determined from linked provincial databases. Subsequent rates of coronary angiography and revascularization after stress testing were ascertained. Of the 112 691 patients with PCI, 67 442 (59.8%) underwent at least 1 stress test, with 38 267 (34.0%) undergoing repeat stress testing (ie, >1 stress test) within 2 years. Patients who underwent stress testing were younger, had less medical comorbidities, were more likely to reside in urban areas, and had higher incomes. Spikes in incidence of repeat stress testing were observed at 3 to 4 months, 6 to 7 months, and 12 to 13 months after the prior stress test. Of those tested, only 5.9% underwent subsequent coronary angiography, and only 3.1% underwent repeat revascularization within 60 days of stress testing. CONCLUSIONS: More than half of all patients undergo cardiac stress testing within 2 years of PCI, with one third undergoing repeat stress tests. Only 1 of 30 tested patients underwent repeat revascularization. These findings reinforce the appropriate use criteria recommendations against routine stress testing after PCI. Further work is needed to aid with the selection of patients most likely to benefit from stress testing after PCI.
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Bagai et al. (2017) conducted an observational in Percutaneous Coronary Intervention (PCI) (n=112,691). Cardiac stress testing was evaluated on Frequency of cardiac stress testing within 2 years of PCI. Cardiac stress testing was performed in 59.8% of patients within 2 years of PCI, with only 3.1% of tested patients undergoing repeat revascularization within 60 days.
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