Cardiac Stress Testing After Coronary Revascularization

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Outcomes Research

Background:

• Appropriate Use Criteria suggest cardiac stress testing (CST) is rarely appropriate within 2 years of percutaneous coronary intervention (PCI) and 5 years of coronary artery bypass grafting (CABG) unless symptoms arise.
• Limited data exist on the utilization and diagnostic yield of CST in patients following coronary revascularization procedures.

Purpose of the Study:

• To determine the frequency of CST use within 2 years after PCI and CABG.
• To assess the diagnostic yield of CST, defined by subsequent coronary angiography and revascularization rates.

Main Methods:

• Retrospective study of 39,648 patients undergoing PCI (29,497) or CABG (10,151) in Alberta, Canada (April 2004 - March 2012).
• Utilized linked provincial databases to track CST frequency between 60 days and 2 years post-revascularization.
• Analyzed patient demographics, comorbidities, and post-CST procedural outcomes.

Main Results:

• Approximately half of patients underwent CST within 2 years post-PCI (48.1%) and post-CABG (44.0%).
• Patients undergoing CST were younger, urban, with higher income, and fewer comorbidities compared to those not tested.
• Low yield observed: 5.2% of PCI patients and 3.6% of CABG patients had subsequent angiography; repeat revascularization occurred in 2.6% (PCI) and 1.1% (CABG).

Conclusions:

• Cardiac stress testing is frequently performed within two years of coronary revascularization in Alberta, Canada, despite guidelines suggesting it's rarely appropriate.
• The diagnostic yield of CST post-PCI and post-CABG is low, with a small proportion of patients proceeding to further interventions.
• Further research is necessary to identify specific patient subgroups who may benefit from CST after revascularization.