Division of Cardiology, The University of Colorado Anschutz Medical Campus, Aurora, CO
Division of General Internal Medicine, The Hospital of the University of Pennsylvania, Philadelphia, PA.
J Am Heart Assoc. 2018 Mar 10;7(6):e007854. doi: 10.1161/JAHA.117.007854.
Scientific statements have championed the measurement of clinical outcomes after cardiac stress testing to better define their value. Using contemporary national data, we sought to describe the characteristics of patients who experience outcomes after stress testing.
Using administrative claims from a large national private insurer, we conducted an observational cohort study of patients without cardiovascular disease aged 25 to 64 years who underwent stress testing from 2006 to 2011 and had at least 1 year of membership in the insurance company before and after testing. We used Kaplan-Meier time-to-event analyses to determine rates of acute myocardial infarction (AMI), elective coronary revascularization, and coronary angiography without revascularization in the year following testing. We used logistic regression to determine factors associated with outcomes, and stratified the cohort into quintiles based on likelihood of experiencing AMI and/or revascularization to describe the characteristics of patients at highest and lowest risk. Among 553 027 patients who underwent stress testing (mean age 50 years, 49% women, 73% white), 0.8% were hospitalized for AMI, 1.8% underwent elective coronary revascularization, and 2.5% underwent coronary angiography without revascularization within 1 year. Patients who were older, male, and white were more likely to undergo subsequent revascularization. Patients in the lowest likelihood quintile were young (mean age 40 years), frequently women (84.7%), had a low incidence of coexisting conditions (5.2% with diabetes mellitus), and had a 0.5% rate of AMI and/or revascularization.
The proportion of US patients younger than 65 who had AMI and/or coronary revascularization after stress testing was low. Assessing risk of subsequent outcomes may be useful in improving patient referrals for stress testing.
科学研究强调了在心脏压力测试后对临床结果进行测量的重要性，以便更好地评估其价值。本研究利用当代全国性数据，旨在描述接受压力测试后发生结局的患者的特征。
本研究使用一家大型私营保险公司的行政索赔数据，对 2006 年至 2011 年间接受压力测试且年龄在 25~64 岁之间、在测试前后均有至少 1 年保险期限、无心血管疾病的患者进行了一项观察性队列研究。采用 Kaplan-Meier 时间事件分析确定测试后 1 年内急性心肌梗死（AMI）、选择性冠状动脉血运重建术（CABG）和无血运重建的冠状动脉造影术的发生率。采用 logistic 回归分析确定与结局相关的因素，并根据发生 AMI 和/或血运重建的可能性将队列分层为五分位数，以描述风险最高和最低的患者的特征。在 553 027 例行压力测试的患者中（平均年龄 50 岁，49%为女性，73%为白人），0.8%因 AMI 住院，1.8%行选择性 CABG，2.5%行无血运重建的冠状动脉造影术。年龄较大、男性和白人患者更有可能接受后续血运重建。可能性最低的五分位数组患者年龄较小（平均年龄 40 岁），女性居多（84.7%），合并症发生率较低（5.2%患有糖尿病），AMI 和/或血运重建的发生率为 0.5%。
在美国，接受压力测试后发生 AMI 和/或冠状动脉血运重建的 65 岁以下患者比例较低。评估后续结局的风险可能有助于改善压力测试的患者转诊。
