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(Ivanhoe Newswire) -- Angioplasty and stenting -- known collectively as percutaneous coronary intervention, or PCI -- are common procedures in heart patients. But are they always necessary?
Researchers from the University of California, San Francisco thought the answer might be no in many cases. They set out to prove the point in a study aimed at seeing how often doctors order their coronary artery disease (CAD) patients to undergo stress testing prior to the procedure.
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The guidelines clearly state patients who make it through the test without signs of ischemia -- inadequate blood supply to the heart -- can be managed just as well with drug treatment alone.
Guidelines for PCI call for documenting ischemia prior to PCI in the vast majority of patients with stable CAD; however, our data suggest that this is not being done consistently, write the authors. Their review of nearly 24,000 patients age 65 and older who had a PCI in 2004 found only about 44 percent underwent stress testing in the 90 days before having the procedure.
The rate of testing also varied considerably according to region of the country, from a high of about 70 percent to a low of about 22 percent. People with a previous cardiac catheterization were less likely to receive stress testing, as were women, those age 85 and older, and those with other medical conditions. Patients were more likely to receive stress testing if they were black or had a history of chest pain.
Since PCIs cost the Medicare program between $10,000 and $15,000 each, the researchers believe more should be done to encourage doctors and hospitals to stick to the guidelines when considering these treatments for their heart disease patients.
SOURCE: Journal of the American Medical Association, published online October 14, 2008
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