Population-based study of the use of cardiac stress imaging and referral for coronary angiography and repeated revascularization after coronary artery bypass graft surgery

Mayo Clin Proc. 2013 Apr;88(4):345-53. doi: 10.1016/j.mayocp.2012.12.002.

Abstract

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%).

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Coronary Angiography / statistics & numerical data*
  • Coronary Artery Bypass / statistics & numerical data*
  • Coronary Artery Disease / diagnosis*
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / surgery
  • Echocardiography, Stress / statistics & numerical data*
  • Exercise Test / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Minnesota
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Recurrence
  • Referral and Consultation / statistics & numerical data*
  • Reoperation
  • Retrospective Studies
  • Survival Rate
  • Tomography, Emission-Computed, Single-Photon / methods
  • Tomography, Emission-Computed, Single-Photon / statistics & numerical data*
  • Treatment Outcome