What is the Relationship Between PCI and Diagnostic Testing?

Increased use of cardiovascular testing after percutaneous coronary intervention (PCI) was found to be associated with an increase in repeat revascularization, according to a study published May 28 in the Journal of the American College of Cardiology.

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The study used claims data from the Centers for Medicare and Medicaid Services linked with clinical data from the NCDR's CathPCI Registry®, and looked 247,052 PCI patients older than 65 years of age, within 656 institutions.

Results showed that 60 days to 720 days after PCI, "a significant difference in the rates of repeat revascularization was found across the four [quartiles], with increasing rates of revascularization as testing quartile increased (13.8 percent, 13.8 percent, 14.7 percent, 15.4 percent for Quartiles 1-4, respectively; [p<0.001])." However, the cumulative incidence rate of death was similar when comparing the quartiles, as was the cumulative incidence of hospitalization for AMI.

In addition, the authors note that the marked variation of testing was not explained by the differences in characteristics of patients and hospitals, as there were no significant differences in patient characteristics among sites stratified by quartile of testing use, which demonstrates that increased patient risk was not associated with increased testing use and vice versa.

The authors conclude that "it is unknown whether increased testing after PCI with increased subsequent repeat revascularization is a marker of higher quality post-PCI care, or simply an indication of increased health care utilization." Moving forward, studies should examine "the indications for and results of post-PCI testing to further assess their use for patients to better understand the associated clinical outcomes."

In a related editorial comment, Mark A. Hlatky, MD, FACC, of the Stanford University School of Medicine, Standford, CA, and Anthony DeMaria, MD, MACC, of the University of California San Diego Medical Center, San Diego, CA, argue that there were significant limitations of the study, such as no data on clinical outcomes such as angina, functional capabilities or quality of life. They add that "these limitations suggest that even though routine stress testing after successful coronary revascularization is associated with more invasive procedures (and higher cost), the effect on clinical outcomes remains uncertain."

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Incidence, Quality of Life, Centers for Medicare and Medicaid Services (U.S.), Hospitalization, United States, Percutaneous Coronary Intervention

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