Stress testing in asymptomatic patients may not be beneficial

Few asymptomatic patients with acute coronary syndrome who undergo PCI followed by stress imaging may actually need revascularization, raising questions about the benefits of stress imaging, a study published online March 31 in Circulation: Cardiovascular Imaging found.

“Rapid advances in cardiac imaging techniques have given physicians exciting tools to diagnose and treat disease,” wrote the researchers, led by Tyler Peterson, MD, of the Mayo Clinic in Rochester, Minn. “However, these advances have also brought a marked increase in the utilization of imaging procedures and concerns over inappropriate use.”

Peterson and colleagues followed 1,848 PCI patients from Olmsted County, Minn., and determined how many later underwent stress imaging, coronary angiography or CABG without angiography as the first procedure after PCI. The researchers evaluated the symptomatology of those who did have post-PCI stress imaging and whether CABG or another PCI occurred within 90 days.

Thirty-eight percent of the 1,848 participants had stress imaging as their first procedure after PCI, and 13 percent had no symptoms at the time of testing. Most of these asymptomatic patients (86 percent) had PCI for acute MI or unstable angina, and 16 of the asymptomatic patients had PCI or CABG within 90 days of stress imaging.

Although their study participants all hailed from one region in Minnesota, the authors noted that their research found that while stress testing in asymptomatic patients is fairly common, it rarely leads to further revascularization.

“The very low rate of downstream revascularization found in our study suggests that stress testing asymptomatic patients post PCI has low value either before or after two years,” they wrote.