Document Detail

Population-based study of the use of cardiac stress imaging and referral for coronary angiography and repeated revascularization after coronary artery bypass graft surgery.
MedLine Citation:
PMID:  23541009     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To assess stress single-photon emission computed tomography (SPECT) and stress echocardiography use after coronary artery bypass grafting (CABG) and their effect on referral for coronary angiography and revascularization.
PATIENTS AND METHODS: The referral, timing, and results of stress imaging after CABG; referral for coronary angiography and revascularization; and all-cause mortality were assessed in this longitudinal, population-based, retrospective study of 1138 Olmsted County, Minnesota, patients undergoing CABG between January 1, 1993, and December 31, 2003.
RESULTS: A total of 570 patients (50.1%) underwent a stress imaging study (341 SPECT and 229 echocardiography) during the study period. Of the 1138 patients, 372 (32.7%) were referred for coronary angiography, and 144 of those patients (12.7%) underwent repeated revascularization (132 percutaneous revascularization and 12 CABG). The median interval between CABG and the index stress imaging study was 3.0 years (25th-75th percentile, 1.2-5.7 years). The results of 75.7% (258 of 341) of the stress SPECT studies and 70.7% (162 of 229) of the stress echocardiograms were abnormal. Seventy-six of 570 patients (13.3%) referred for stress imaging underwent coronary angiography within 180 days after the stress test. Repeated coronary revascularization was performed in 25 patients (4.4%) who underwent a stress imaging study within the preceding 180 days. The 5- and 10-year survival rates in the entire study cohort (83.5% and 65.1%, respectively) were not significantly different than predicted for the age- and sex-matched Minnesota population.
CONCLUSION: Half of this community-based population of patients with CABG underwent stress SPECT or echocardiography during median follow-up of 8.9 years. Despite that approximately 75% of the results of stress imaging studies were abnormal, subsequent referral for coronary angiography within 180 days was low (13.3%), and the yield for repeated revascularization was very low (4.4%).
J Wells Askew; Todd D Miller; Kevin L Greason; Hartzell V Schaff; Robert B McCully; Daniel J Crusan; David O Hodge; Raymond J Gibbons
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Mayo Clinic proceedings     Volume:  88     ISSN:  1942-5546     ISO Abbreviation:  Mayo Clin. Proc.     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-04-01     Completed Date:  2013-07-01     Revised Date:  2013-12-13    
Medline Journal Info:
Nlm Unique ID:  0405543     Medline TA:  Mayo Clin Proc     Country:  England    
Other Details:
Languages:  eng     Pagination:  345-53     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Coronary Angiography / statistics & numerical data,  utilization*
Coronary Artery Bypass / statistics & numerical data*
Coronary Artery Disease / diagnosis*,  mortality,  surgery
Echocardiography, Stress / statistics & numerical data*
Exercise Test / statistics & numerical data,  utilization
Follow-Up Studies
Kaplan-Meier Estimate
Middle Aged
Physician's Practice Patterns / statistics & numerical data*
Referral and Consultation / statistics & numerical data,  utilization*
Retrospective Studies
Survival Rate
Tomography, Emission-Computed, Single-Photon / methods,  statistics & numerical data,  utilization*
Treatment Outcome

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