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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).

The authors apparently did not have access to data on intracoronary physiologic measurements such as fractional flow reserve (FFR), an important measure of the hemodynamic significance of intermediate (40%-70% diameter luminal narrowing) coronary arterial . . . [Full Text of this Article]

William J. Kostis, PhD, MD
wkostis1@jhmi.edu
Department of Medicine

Steven P. Schulman, MD
Division of Cardiology
Johns Hopkins University School of Medicine
Baltimore, Maryland

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RELATED ARTICLE

Frequency of Stress Testing to Document Ischemia Prior to Elective Percutaneous Coronary Intervention
Grace A. Lin, R. Adams Dudley, F. L. Lucas, David J. Malenka, Eric Vittinghoff, and Rita F. Redberg
JAMA. 2008;300(15):1765-1773.
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Documenting Ischemia Prior to Elective Percutaneous Coronary Intervention—Reply
Grace A. Lin, David J. Malenka, and Rita F. Redberg
JAMA. 2009;301(10):1018-1019.
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