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Many Patients Lack Suggested Test Before Elective PCI

Despite guidelines, in 90 days before percutaneous coronary intervention, only 45 percent underwent stress testing

TUESDAY, Oct. 14 (HealthDay News) -- Most patients in a Medicare sample with stable coronary artery disease didn't undergo stress testing in the 90 days before elective percutaneous coronary intervention, according to research published in the Oct. 15 issue of the Journal of the American Medical Association.

Grace A. Lin, M.D., of the University of California San Francisco, and colleagues analyzed data from 23,887 Medicare fee-for-service beneficiaries aged 65 and older who underwent an elective percutaneous coronary intervention (PCI). Guidelines from prominent organizations specify that in patients with stable angina, at least moderate ischemia must be associated with vessels that are to be dilated.

In the 90 days before the PCI, 44.5 percent of patients underwent stress testing, with wide regional variation, the researchers report. Factors associated with a lower likelihood of stress testing included female gender, age of 85 or older and history of congestive heart failure, the investigators found. History of chest pain and black race were associated with a greater likelihood, the report indicates.

"As noted by the authors, these findings are not necessarily probative of misutilization. Administrative databases such as this do not include a variety of clinical factors that might explain and justify the observed patterns of utilization. Nevertheless, the analyses that were performed leave the clear impression that referral for PCI was influenced less by objective evidence of ischemia than by incidental factors. The wide geographic variation in rates of stress testing before PCI further supports this conclusion," write the authors of an accompanying editorial.

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