Functional testing after percutaneous transluminal coronary angioplasty inCanada and the United States: A survey of practice patterns

BACKGROUND: Authorities recommend various strategies to identify restenosis in patients who have undergone percutaneous transluminal coronary angiopla sty (PTCA). Some authorities recommend a routine functional testing strateg y, while others recommend a clinically driven strategy. MATERIALS AND METHODS: To examine the patterns of use of post-PTCA. functio nal testing, 89 directors of cardiac catheterization laboratories in Canada and the United States were surveyed. RESULTS: Demographic characteristics of the Canadian and American responden ts were similar, including median age (43 and 45 years, respectively) and m edian number of PTCAs performed each year (200 each). Canadians were more l ikely to employ a routine functional testing strategy than Americans (62% v ersus 38%), white Americans were more likely to employ stress imaging studi es than Canadians (49% versus 35%). Overall, close to half (44%) of all the cardiologists employed a routine functional testing strategy. Physicians w ho employed a routine functional testing strategy performed the first funct ional test a median of three months after PTCA and the second a median of s ix months after PTCA. Both Canadian and American cardiologists tended to un derestimate the incidence of restenosis after PTCA (33% without a stent and 18% with a stent) and to overestimate the sensitivity of exercise treadmil l testing for the detection of restenosis (63%). CONCLUSIONS: The use of functional testing after PTCA varies widely. Canadi an cardiologists are more likely to employ a routine functional testing str ategy than American cardiologists. Close to half of the cardiologists surve yed employed a routine functional testing Strategy. These results indicate that there is little consensus regarding the use of functional testing afte r PTCA.