Stress testing after percutaneous coronary interventions: a population-based study

Area of Science:

• Cardiology
• Health Services Research
• Medical Economics

Background:

• Routine stress testing post-percutaneous coronary intervention (PCI) is common for detecting in-stent restenosis.
• Recent evidence questions the routine indication for post-PCI stress testing.
• Assessing temporal trends and utilization factors of stress testing after PCI is crucial.

Purpose of the Study:

• To evaluate trends in stress testing utilization within two years following percutaneous coronary intervention (PCI).
• To identify patient and hospital factors associated with the use of stress testing after PCI.

Main Methods:

• An observational study analyzed 128,380 patients undergoing PCI in Ontario, Canada (2004-2012).
• Multivariable logistic regression models were employed to determine factors associated with stress test use.
• The primary outcome was the occurrence of stress testing within two years post-PCI.

Main Results:

• The rate of stress testing within two years post-PCI decreased from 68.1% in 2004 to 60.4% in 2012 (p < 0.001).
• Reductions in stress testing were consistent across different restenosis risks and stent types.
• Older patients, those with diabetes, prior myocardial infarction, heart failure, or comorbidities were less likely to receive stress tests. Higher income and non-teaching hospital status were associated with increased testing.

Conclusions:

• Stress testing utilization after PCI has declined over time.
• The decision to perform stress tests was not consistently aligned with patients' baseline risk for adverse outcomes or restenosis.
• Nonclinical factors, including socioeconomic status and hospital teaching status, significantly influenced the utilization of stress testing post-PCI.