Role of stress testing and cardiac imaging in patients who have undergone previous coronary revascularization

Stress testing and cardiac imaging have been part of established practice for evaluating patients with suspected coronary disease. With the increasing use of revascularization procedures, there is increasing interest in using these tests for evaluation of patients with possible coronary restenosis or graft coronary disease. Although a number of reports have suggested that nuclear and echocardiographic imaging have high diagnostic accuracy for these conditions, the usefulness of imaging for diagnostic purposes must be questioned, primarily because of verification bias. When used for assessment of prognosis, however, nuclear imaging clearly has been shown to function well in postbypass surgery patients. Exercise hemodynamics, particularly exercise capacity and heart rate response, may also be powerful predictors of risk in these patients. Future work will be needed to determine whether stress echocardiography has similar prognostic properties among postbypass patients and to define the optimal role of imaging in patients who have had recent percutaneous coronary intervention.