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, 35 (1), e3

Long-Term Outcomes in Patients Undergoing Percutaneous Coronary Intervention With or Without Preprocedural Exercise Stress Test

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Long-Term Outcomes in Patients Undergoing Percutaneous Coronary Intervention With or Without Preprocedural Exercise Stress Test

Jihoon Kim et al. J Korean Med Sci.

Abstract

Background: Although current guidelines recommend noninvasive stress tests prior to elective percutaneous coronary intervention (PCI), it is unknown whether antecedent exercise stress test (EST) affects the outcomes of patients undergoing PCI for stable ischemic heart disease (SIHD). This study aimed to investigate long-term outcomes in patients undergoing elective PCI with or without EST.

Methods: We studied 2,674 patients undergoing elective PCI using drug-eluting stents for SIHD. Patients were divided into the 2 groups: the test group underwent EST with a positive result within 180 days prior to PCI (n = 668), whereas the non-test group did not undergo any noninvasive stress tests (n = 2,006). The primary outcome was all-cause death or myocardial infarction (MI).

Results: Over 5 years after the index PCI, the risk of all-cause death or MI was significantly lower in the test group than in the non-test group in overall population (3.3% vs. 10.9%; adjusted hazard ratio [HR], 0.34; 95% confidence interval [CI], 0.22-0.55; P < 0.001), and in propensity score-matched population (668 pairs) (3.3% vs. 6.3%; adjusted HR, 0.52; 95% CI, 0.30-0.89; P = 0.018). However, the incidence of any revascularization was similar between the 2 groups in overall (16.7% vs. 16.8%; adjusted HR, 0.99; 95% CI, 0.79-1.25; P = 0.962) and matched population (16.7% vs. 18.3%; adjusted HR, 0.91; 95% CI, 0.70-1.19; P = 0.509).

Conclusion: Patients who underwent elective PCI with EST had a reduced risk of all-cause death or MI than those undergoing PCI without stress tests.

Keywords: Chronic Stable Angina; Exercise Test; Percutaneous Coronary Intervention.

Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Study population.
DES = drug-eluting stent, PCI = percutaneous coronary intervention, EST = exercise stress test.
Fig. 2
Fig. 2. Clinical outcomes at 5 years according to the presence of EST prior to PCI in overall population of patients with SIHD. (A) All-cause death or nonfatal MI, (B) all-cause death, (C) nonfatal MI, (D) cardiac death or nonfatal MI, (E) cardiac death, and (F) any revascularization.
Adjusted HR and its CI was calculated by multivariable Cox regression analysis using clinically relevant variables including age, gender, diabetes mellitus, extent of coronary artery disease, and types of stent used. EST = exercise stress test, PCI = percutaneous coronary intervention, SIHD = stable ischemic heart disease, MI = myocardial infarction, HR = hazard ratio, CI = confidence interval.
Fig. 3
Fig. 3. Clinical outcomes at 5 years according to the presence of EST prior to PCI in matched population of patients with SIHD. (A) All-cause death or nonfatal MI, (B) all-cause death, (C) nonfatal MI, (D) cardiac death or nonfatal MI, (E) cardiac death, and (F) any revascularization.
Adjusted HR and its CI was calculated by multivariable Cox regression analysis using clinically relevant variables including age, gender, diabetes mellitus, extent of coronary artery disease, and types of stent used. EST = exercise stress test, PCI = percutaneous coronary intervention, SIHD = stable ischemic heart disease, MI = myocardial infarction, HR = hazard ratio, CI = confidence interval.
Fig. 4
Fig. 4. All-cause death or nonfatal MI at 5 years according to the presence of EST prior to PCI in various subgroups.
HR and its CI was calculated by univariable Cox regression analysis in the propensity score-matched population. MI = myocardial infarction, EST = exercise stress test, PCI = percutaneous coronary intervention, METs = metabolic equivalents, NA = not available, HR = hazard ratio, CI = confidence interval. aBecause of unknown exercise capacity or Duke treadmill score in the non-test group, each subgroup of the test group was compared with the entire non-test group.

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