Downstream Testing and Subsequent Procedures After Coronary Computed Tomographic Angiography Following Coronary Stenting in Patients ≥65 Years of Age - 28/08/12

Résumé |
Limited data are available on the use of coronary computed tomographic angiography (CCTA) in patients who have received percutaneous coronary intervention (PCI). To evaluate patterns of cardiac testing including CCTA after PCI, we created a retrospective observational dataset linking National Cardiovascular Data Registry CathPCI Registry baseline data with longitudinal inpatient and outpatient Medicare claims data for patients who received coronary stenting from November 1, 2005 through December 31, 2007. In 192,009 patients with PCI (median age 74 years), the first test after coronary stenting was CCTA for 553 (0.3%), stress testing for 89,900 (46.8%), and coronary angiography for 22,308 (11.6%); 79,248 (41.3%) had no further testing. Patients referred to CCTA first generally had similar or lower baseline risk than those referred for stress testing or catheterization first. Compared to patients with stress testing first after PCI, patients who underwent CCTA first had higher unadjusted rates of subsequent noninvasive testing (10% vs 3%), catheterization (26% vs 15%), and revascularization (13% vs 8%) within 90 days of initial testing after PCI (p <0.0001 for all comparisons). In conclusion, despite similar or lesser-risk profiles, patients initially evaluated with CCTA after PCI had more downstream testing and revascularization than patients initially evaluated with stress testing. It is unclear whether these differences derive from patient selection, performance of CCTA compared to other testing strategies, or the association of early adoption of CCTA with distinct patterns of care.
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| This project was sponsored by the Agency for Healthcare Research and Quality, United States Department of Health and Human Services, Rockville, Maryland as part of the Cardiovascular Consortium and funded under Project ID 24-DKE-3 and Work Assignment HHSA290-2005-0032-I-TO4-WA3 as part of the Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) program. Additional support was obtained from the National Cardiovascular Data Registry, American College of Cardiology, Washington, D.C. |
Vol 110 - N° 6
P. 776-783 - septembre 2012 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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