Patterns of stress testing and diagnostic catheterization after coronary stenting in 250 350 medicare beneficiaries.

Mudrick DW, Shah BR, McCoy LA, Lytle BL, Masoudi FA, Federspiel JJ, Cowper PA, Green C, Douglas PS.

Source

Duke University Medical Center, Durham, NC 27705, USA.

Erratum in

Circ Cardiovasc Imaging. 2013 May 1;6(3):e21.

Abstract

BACKGROUND:

Patterns of noninvasive stress test (ST) and invasive coronary angiography (CA) utilization after percutaneous coronary intervention (PCI) are not well described in older populations.

METHODS AND RESULTS:

We linked National Cardiovascular Data Registry CathPCI Registry data with longitudinal Medicare claims data for 250 350 patients undergoing PCI from 2005 to 2007 and described subsequent testing and outcomes. Between 60 days post-PCI and end of follow-up (median 24 months), 49% (n=122 894) received ST first, 10% (n=25 512) underwent invasive CA first, and 41% (n=101 944) had no testing. Several clinical risk factors at time of index PCI were associated with decreased likelihood of downstream testing (ST or CA, P<0 .05="" 0.784="" 0.804="" 0.880="" 0.925="" 0.946="" 0.954="" 10-year="" 316="" 472="" 48="" 53="" 894="" 90="" age="" all="" and="" ca="" compared="" corrected="" days="" diabetes="" failure="" fifteen="" first="" for="" hazard="" heart="" including="" increase="" male="" mellitus="" n="13" of="" older="" p="" patients="" per="" percent="" proceeded="" ratio="" renal="" revascularization="" sex="" smoking="" st="" subsequent="" testing="" these="" to="" underwent="" with="" within="">

CONCLUSIONS:

In this descriptive analysis, ST and invasive CA were common in older patients after PCI. Paradoxically, patients with higher risk features at baseline were less likely to undergo post-PCI testing. The revascularization yield was low on patients referred for ST after PCI, with only 7% [corrected] undergoing revascularization within 90 days.