New study questions PCIs for chest pain

Hundreds of thousands of Americans may be having costly and unnecessary heart procedures for chest pain, according to a study in the Journal of the American Medical Association.

More than half of patients with angina are undergoing angioplasty-stent procedures, known as PCI, without first getting a stress test to determine if clogged arteries are restricting blood flow in their hearts, the study found. For patients with stable angina, such procedures - which average about $14,000 nationally - are no better at stopping heart attacks and deaths than medications.

The study by researchers in California, Maine and New Hampshire examined a random sample of 23,887 Medicare beneficiaries who had PCI in 2004. They found a wide variation in the rate of testing across the nation.

Overall, 45 percent of patients were tested. Patients in Philadelphia and its Pennsylvania suburbs got the stress tests before PCI 47 percent of the time, while 39 percent of those in South Jersey had the test first. PCI patients living in Rochester, Minn., where the Mayo Clinic's hospital is located, were the most likely to get the test at 71 percent, while those in Fresno, Calif., 22 percent, were least likely.

The guidelines of the major heart care organizations recommend such testing before a patient with stable angina to undergoes PCI. They estimate that the procedure has accounted for at least 10 percent of the increase in Medicare spending since the mid-1990s.

"It is important to document that patients are receiving [angioplasty-stents] for appropriate indications to ensure optimal use of Medicare resources," they concluded.

And for patients, the study suggests it is important to ask their doctor about whether they should have a stress test before having angioplasty.

Contact staff writer Josh Goldstein at 215-854-4733 or jgoldstein@phillynews.com.