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The Utilization of Stress Tests Prior to Percutaneous Coronary Intervention for Stable Coronary Artery Disease in
Ho-Pang Yang1, Guang-Uei Hung2, Cheng-Li Lin3,4
1Department of Cardiology, Show Chwan Memorial Hospital.
Insights
Nearly 60% of stable coronary artery disease (CAD) patients underwent stress testing before percutaneous coronary intervention (PCI), with myocardial perfusion imaging (MPI) being the most frequent diagnostic tool. This study analyzed stress test utilization in CAD patients prior to elective PCI.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Health Services Research
Background:
- Non-invasive stress testing is crucial for guiding percutaneous coronary intervention (PCI) in stable coronary artery disease (CAD).
- Understanding the utilization patterns of pre-PCI stress tests is essential for optimizing patient care pathways.
Purpose of the Study:
- To investigate the utilization of stress tests prior to elective PCI in a nationwide cohort of stable CAD patients.
- To identify patient characteristics associated with the use of stress tests before PCI.
Main Methods:
- Retrospective analysis of the Longitudinal Health Insurance Database 2000 (LHID2000) in Taiwan.
- Inclusion of patients undergoing elective PCI for stable CAD between 2000 and 2013.
- Examination of stress tests (MPI, TET, SE) performed within 90 days before PCI and associated patient factors.
Main Results:
- 58.4% of 3,163 stable CAD patients received at least one stress test before elective PCI.
- Myocardial perfusion imaging (MPI) was the most common test (79.1%), followed by treadmill exercise test (TET) (66.4%).
- Factors associated with increased stress test use included younger age (<80), regional hospital care, and hyperlipidemia; factors associated with decreased use included higher comorbidity scores, prior catheterization, and heart failure.
Conclusions:
- Approximately 60% of stable CAD patients undergo pre-PCI stress testing, with MPI being the predominant method.
- Patient demographics and clinical factors influence the likelihood of receiving stress tests before elective PCI.
Background:
Ischemia shown in non-invasive tests is considered to be a fundamental requirement for treating patients with stable coronary artery disease (CAD) with a percutaneous coronary intervention (PCI). In a nationwide cohort, we investigated the utilization of stress tests, including myocardial perfusion imaging (MPI), treadmill exercise test (TET) and stress echocardiography (SE) prior to elective PCI.
Methods:
This retrospective study used the Longitudinal Health Insurance Database 2000 (LHID2000) of the National Health Insurance program in Taiwan. The LHID2000 is comprised of one million randomly sampled beneficiaries. We enrolled patients receiving elective PCI for stable CAD from 2000 to 2013. Stress tests performed within 90 days prior to PCI and patient characteristics correlated with the utilization of stress tests were investigated.
Results:
During the investigation period, 3,163 patients received elective PCI for stable CAD and 1,847 (58.4%) patients had at least one stress test within 90 days prior to PCI. Among them, 1,461 (79.1%) had MPI, 1,228 had TET (66.4%) and only 1 had SE (0.05%). Age < 80 years, regional hospital and hyperlipidemia were independently associated with an increased likelihood of receiving stress tests. On the other hand, Charlson-comorbidity index score ≥ 1, prior catheterization and heart failure were independently associated with a decreased likelihood of receiving stress tests.
Conclusions:
In the setting of stable CAD, almost 60% of our patients received stress tests within 90 days prior to elective PCI, and MPI was the most commonly used test.
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