Functional testing after percutaneous transluminal coronary angioplasty in Canada and the United States: a survey of practice patterns.

BACKGROUND: Authorities recommend various strategies to identify restenosis in patients who have undergone percutaneous transluminal coronary angioplasty (PTCA). Some authorities recommend a routine functional testing strategy, while others recommend a clinically driven strategy.
MATERIALS AND METHODS: To examine the patterns of use of post-PTCA functional testing, 89 directors of cardiac catheterization laboratories in Canada and the United States were surveyed.
RESULTS: Demographic characteristics of the Canadian and American respondents were similar, including median age (43 and 45 years, respectively) and median number of PTCAs performed each year (200 each). Canadians were more likely to employ a routine functional testing strategy than Americans (62% versus 38%), while Americans were more likely to employ stress imaging studies than Canadians (49% versus 35%). Overall, close to half (44%) of all the cardiologists employed a routine functional testing strategy. Physicians who employed a routine functional testing strategy performed the first functional test a median of three months after PTCA and the second a median of six months after PTCA. Both Canadian and American cardiologists tended to underestimate the incidence of restenosis after PTCA (33% without a stent and 18% with a stent) and to overestimate the sensitivity of exercise treadmill testing for the detection of restenosis (63%).
CONCLUSIONS: The use of functional testing after PTCA varies widely. Canadian cardiologists are more likely to employ a routine functional testing strategy than American cardiologists. Close to half of the cardiologists surveyed employed a routine functional testing strategy. These results indicate that there is little consensus regarding the use of functional testing after PTCA.