To the Editor: In their observational cohort study of Medicare fee-for-service beneficiaries aged 65 years or older, Dr Lin and colleagues1 reported that the majority of patients with stable coronary artery disease did not undergo stress testing to document ischemia within 90 days prior to elective percutaneous coronary intervention (PCI). The authors state that for patients with stable angina, any vessels to be dilated must be shown to be “associated with a moderate to severe degree of ischemia on noninvasive testing” (referring to the class IIa recommendation in section 5.1 on page e205 of the guidelines from the American College of Cardiology, the American Heart Association, and the Society for Cardiovascular Angiography and Intervention [ACC/AHA/SCAI]2).
Kostis WJ, Schulman SP. Documenting Ischemia Prior to Elective Percutaneous Coronary Intervention. JAMA. 2009;301(10):1018-1019. doi:10.1001/jama.2009.258