BACKGROUND: Guidelines advise testing for ischemia, such as with stress testing, before elective percutaneous coronary intervention (PCI). However, pre-PCI stress testing is not always done; the implications of this practice are not known. Our objective was to evaluate whether receipt of stress testing before elective PCI predicts mortality. METHODS AND RESULTS: Using claims data from a 20% random sample of Medicare beneficiaries, we identified patients who had elective PCI in 2004 and followed them for a median of 3.4 years (n=23 887). Cox proportional hazards models were used to test the relationship of pre-PCI stress testing to survival. Population-based rates of elective PCI and stress testing were calculated for 306 hospital referral regions and categorized into 4 groups: high stress test/high PCI, low stress test/low PCI, low stress test/high PCI, and high stress/low PCI regions. Cox modeling was used to test whether category of hospital referral regions is related to survival. Patients who underwent pre-PCI stress testing had a 13% lower risk of mortality than those who did not (adjusted hazard ratio, 0.87; 95% confidence interval, 0.81-0.92) after median follow-up of 3.4 years. Patients in low stress test/high PCI regions had a 14% higher risk of mortality than those in high stress test/high PCI regions (adjusted hazard ratio, 1.14; 95% confidence interval, 1.03-1.26). CONCLUSIONS: Pre-PCI stress testing is associated with lower mortality in patients undergoing elective PCI. Greater adherence to guidelines with respect to documenting ischemia before elective PCI may result in improved outcomes for patients.
BACKGROUND: Guidelines advise testing for ischemia, such as with stress testing, before elective percutaneous coronary intervention (PCI). However, pre-PCI stress testing is not always done; the implications of this practice are not known. Our objective was to evaluate whether receipt of stress testing before elective PCI predicts mortality. METHODS AND RESULTS: Using claims data from a 20% random sample of Medicare beneficiaries, we identified patients who had elective PCI in 2004 and followed them for a median of 3.4 years (n=23 887). Cox proportional hazards models were used to test the relationship of pre-PCI stress testing to survival. Population-based rates of elective PCI and stress testing were calculated for 306 hospital referral regions and categorized into 4 groups: high stress test/high PCI, low stress test/low PCI, low stress test/high PCI, and high stress/low PCI regions. Cox modeling was used to test whether category of hospital referral regions is related to survival. Patients who underwent pre-PCI stress testing had a 13% lower risk of mortality than those who did not (adjusted hazard ratio, 0.87; 95% confidence interval, 0.81-0.92) after median follow-up of 3.4 years. Patients in low stress test/high PCI regions had a 14% higher risk of mortality than those in high stress test/high PCI regions (adjusted hazard ratio, 1.14; 95% confidence interval, 1.03-1.26). CONCLUSIONS: Pre-PCI stress testing is associated with lower mortality in patients undergoing elective PCI. Greater adherence to guidelines with respect to documenting ischemia before elective PCI may result in improved outcomes for patients.
Authors: Glenn N Levine; Eric R Bates; James C Blankenship; Steven R Bailey; John A Bittl; Bojan Cercek; Charles E Chambers; Stephen G Ellis; Robert A Guyton; Steven M Hollenberg; Umesh N Khot; Richard A Lange; Laura Mauri; Roxana Mehran; Issam D Moussa; Debabrata Mukherjee; Brahmajee K Nallamothu; Henry H Ting Journal: Circulation Date: 2011-11-07 Impact factor: 29.690
Authors: Rory Hachamovitch; Alan Rozanski; Sean W Hayes; Louise E J Thomson; Guido Germano; John D Friedman; Ishac Cohen; Daniel S Berman Journal: J Nucl Cardiol Date: 2006-11 Impact factor: 5.952
Authors: William E Boden; Robert A O'Rourke; Koon K Teo; Pamela M Hartigan; David J Maron; William J Kostuk; Merril Knudtson; Marcin Dada; Paul Casperson; Crystal L Harris; Bernard R Chaitman; Leslee Shaw; Gilbert Gosselin; Shah Nawaz; Lawrence M Title; Gerald Gau; Alvin S Blaustein; David C Booth; Eric R Bates; John A Spertus; Daniel S Berman; G B John Mancini; William S Weintraub Journal: N Engl J Med Date: 2007-03-26 Impact factor: 91.245
Authors: Pim A L Tonino; Bernard De Bruyne; Nico H J Pijls; Uwe Siebert; Fumiaki Ikeno; Marcel van' t Veer; Volker Klauss; Ganesh Manoharan; Thomas Engstrøm; Keith G Oldroyd; Peter N Ver Lee; Philip A MacCarthy; William F Fearon Journal: N Engl J Med Date: 2009-01-15 Impact factor: 91.245
Authors: Grace A Lin; R Adams Dudley; F L Lucas; David J Malenka; Eric Vittinghoff; Rita F Redberg Journal: JAMA Date: 2008-10-15 Impact factor: 56.272
Authors: Leslee J Shaw; Daniel S Berman; David J Maron; G B John Mancini; Sean W Hayes; Pamela M Hartigan; William S Weintraub; Robert A O'Rourke; Marcin Dada; John A Spertus; Bernard R Chaitman; John Friedman; Piotr Slomka; Gary V Heller; Guido Germano; Gilbert Gosselin; Peter Berger; William J Kostuk; Ronald G Schwartz; Merill Knudtson; Emir Veledar; Eric R Bates; Benjamin McCallister; Koon K Teo; William E Boden Journal: Circulation Date: 2008-02-11 Impact factor: 29.690