Bagai Akshay, Eberg Maria, Koh Maria, Cheema Asim N, Yan Andrew T, Dhoot Arti, Bhavnani Sanjeev P, Wijeysundera Harindra C, Bhatia R Sacha, Kaul Padma, Goodman Shaun G, Ko Dennis T
From the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada (A.B.); Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Ontario, Canada (A.B., A.N.C., A.T.Y., A.D., S.G.G.); Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (M.E., M.K., H.C.W., D.T.K.); Division of Cardiology, Scripps Clinic and Research Institute, San Diego, CA (S.P.B.); Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (H.C.W., D.T.K.); Peter Munk Cardiac Center of the University Health Network, University of Toronto, Ontario, Canada (S.B.); Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, Ontario, Canada (S.B.); and Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada (P.K., S.G.G.).
Circ Cardiovasc Qual Outcomes. 2017 Oct;10(10). doi: 10.1161/CIRCOUTCOMES.117.003660.
The appropriate use criteria considers cardiac stress testing within 2 years after percutaneous coronary intervention (PCI) to be rarely appropriate, unless prompted by symptoms or change in clinical status. Little is known about the patterns of cardiac stress testing after PCI in the single-payer Canadian healthcare system, where mechanisms for reimbursement are different from the United States.
Frequency and timing of cardiac stress testing within 2 years of PCI performed between April 2004 and March 2013 in Ontario, Canada, was determined from linked provincial databases. Subsequent rates of coronary angiography and revascularization after stress testing were ascertained. Of the 112 691 patients with PCI, 67 442 (59.8%) underwent at least 1 stress test, with 38 267 (34.0%) undergoing repeat stress testing (ie, >1 stress test) within 2 years. Patients who underwent stress testing were younger, had less medical comorbidities, were more likely to reside in urban areas, and had higher incomes. Spikes in incidence of repeat stress testing were observed at 3 to 4 months, 6 to 7 months, and 12 to 13 months after the prior stress test. Of those tested, only 5.9% underwent subsequent coronary angiography, and only 3.1% underwent repeat revascularization within 60 days of stress testing.
More than half of all patients undergo cardiac stress testing within 2 years of PCI, with one third undergoing repeat stress tests. Only 1 of 30 tested patients underwent repeat revascularization. These findings reinforce the appropriate use criteria recommendations against routine stress testing after PCI. Further work is needed to aid with the selection of patients most likely to benefit from stress testing after PCI.
适当使用标准认为，经皮冠状动脉介入治疗（PCI）后2年内进行心脏负荷试验很少是合适的，除非有症状提示或临床状况发生变化。在加拿大单一支付者医疗体系中，PCI术后心脏负荷试验的模式鲜为人知，该体系的报销机制与美国不同。
通过省级数据库链接，确定了2004年4月至2013年3月在加拿大安大略省进行PCI后2年内心脏负荷试验的频率和时间。确定了负荷试验后冠状动脉造影和血运重建的后续发生率。在112691例PCI患者中，67442例（59.8%）至少进行了1次负荷试验，其中38267例（34.0%）在2年内进行了重复负荷试验（即>1次负荷试验）。接受负荷试验的患者更年轻，合并症更少，更有可能居住在城市地区，收入更高。在前一次负荷试验后的3至4个月、6至7个月和12至13个月观察到重复负荷试验发生率的峰值。在接受检测的患者中，只有5.9%的患者随后进行了冠状动脉造影，只有3.1%的患者在负荷试验后60天内进行了重复血运重建。
超过一半的患者在PCI后2年内进行心脏负荷试验，三分之一的患者进行重复负荷试验。每30例接受检测的患者中只有1例进行了重复血运重建。这些发现强化了PCI后不建议进行常规负荷试验的适当使用标准建议。需要进一步开展工作，以帮助选择最有可能从PCI后负荷试验中获益的患者。
