Downstream Testing and Subsequent Procedures After Coronary Computed Tomographic Angiography Following Coronary Stenting in Patients ≥65 Years of Age

• Published in: The American journal of cardiology Vol. 110; no. 6; pp. 776 - 783
• Main Authors: Mudrick, Daniel, MD, MPH, Kaltenbach, Lisa A., MS, Shah, Bimal, MD, MBA, Lytle, Barbara, MS, Masoudi, Frederick A., MD, MSPH, Mark, Daniel B., MD, Federspiel, Jerome J., AB, Cowper, Patricia A., PhD, Green, Cynthia, PhD, Douglas, Pamela S., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15-09-2012; Elsevier; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Cardiovascular system; Coronary Angiography - utilization; Coronary Artery Disease - diagnosis; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - therapy; Coronary heart disease; Coronary vessels; Exercise Test - utilization; Female; Follow-Up Studies; Heart; Hospitals; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Medicare; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Risk Factors; Stents; Tomography, X-Ray Computed - utilization; United States; Human; Angiography; Radiodiagnosis; Coronary artery; Instrumentation therapy; Cardiovascular disease; Patient; Instrumental dilatation; Coronary arteriography; Coronary heart disease; Stent; Medical imagery; Procedure; Computerized axial tomography; Circulatory system; Cardiology; Angiocomputed tomography; Age
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2012.05.004

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.