Research Activities, October 2013
Stress imaging may be overused in Medicare patients with stable coronary artery disease
Stress testing within 5 years of coronary artery bypass graft (CABG) surgery or percutaneous coronary artery intervention (PCI) is not appropriate for asymptomatic patients, according to current appropriateness criteria. Current guidelines also indicate that coronary revascularization should not be undertaken in asymptomatic patients unless evidence by non-invasive imaging shows high-risk ischemia.
The use of stress imaging studies is largely dependent on provider-level practice patterns, and greater rates of testing do not appear to strongly predict greater rates of repeat revascularization, according to a new study. Therefore, many of these tests may not be necessary, conclude the researchers. They studied 54,124 Medicare patients who received either CABG or PCI in 2003-2004. They found that over an average follow-up period of more than 4 years, only 10.3 percent of the 13,292 repeat revascularizations were preceded by a heart attack. However, geographic variation by hospital referral regions in the use of stress testing was only modestly associated with greater rates of repeat revascularization.
The mode of initial revascularization may also affect the repeat revascularization rate. At a 6-year followup, PCI patients were more likely than CABG patients to have received revascularization. This suggests that CABG provides a greater likelihood of avoiding a repeat revascularization. The variation in provider-level stress testing rates was not explored in this study, which was funded by AHRQ (T32 HS00032).
See "Stress imaging use and repeat revascularization among Medicare patients with high-risk coronary artery disease," by Joseph S. Rossi, M.D., Jerome J. Federspiel, A.B., Daniel J. Crespin, M.S.P.H., and others in the American Journal of Cardiology 110, pp. 1270-1274, 2012.