Korean Circ J.  2020 May;50(5):406-417. 10.4070/kcj.2019.0319.

Comparison of Exercise Performance and Clinical Outcome Between Functional Complete and Incomplete Revascularization

• Kim J
• Lee JM
• Choi SH
• Choi KH
• Park TK
• Park SJ
• Yang JH
• Song YB
• Hahn JY
• Jang MJ
• Koo BK
• Gwon HC

• KMID: 2471779
• DOI: http://doi.org/10.4070/kcj.2019.0319

Abstract

BACKGROUND AND OBJECTIVES
Although percutaneous coronary intervention (PCI) is recommended to improve symptoms in patients with stable ischemic heart disease (SIHD), improvement of exercise performance is controversial. This study aimed to investigate changes in exercise duration after PCI according to functional completeness of revascularization by comparing pre- and post-PCI exercise stress test (EST).
METHODS
Patients with SIHD were enrolled from a prospective PCI registry, and divided into 2 groups: 1) functional complete revascularization (CR) group had a positive EST before PCI and negative EST after PCI, 2) functional incomplete revascularization (IR) group had positive EST before and after PCI. Primary outcome was change in exercise duration after PCI and secondary outcome was major adverse cardiac events (MACE, a composite of any death, any myocardial infarction, and any ischemia-driven revascularization) at 3 years after PCI.
RESULTS
A total of 256 patients (149 for CR group, and 107 for IR group) were eligible for analysis. Before PCI, exercise duration was not significantly different between the functional CR and IR groups (median 540 [interquartile range; IQR, 414, 602] vs. 480 [402, 589] seconds, p=0.091). After PCI, however, the CR group had a significantly higher increment of exercise duration than the IR group (median 62.0 [IQR, 12.0, 141.0] vs. 30.0 [−11.0, 103.5] seconds, p=0.011). The functional CR group also had a significantly lower risk of 3-year MACE (6.2% vs. 26.1%; adjusted hazard ratio, 0.19; 95% confidence interval, 0.09-0.41; p<0.001).
CONCLUSIONS
Functional CR showed a higher increment of exercise duration than functional IR.

Keyword

Chronic stable angina; Percutaneous coronary intervention; Exercise; Prognosis

MeSH Terms

Angina, Stable
Exercise Test
Humans
Myocardial Infarction
Myocardial Ischemia
Percutaneous Coronary Intervention
Prognosis
Prospective Studies

Figure

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  Figure 1 Exercise duration according to functional completeness of revascularization. (A) Exercise duration before PCI; (B) Exercise duration after PCI; (C) Changes in exercise duration after PCI.CR = complete revascularization; IR = incomplete revascularization; PCI = percutaneous coronary intervention.

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  Figure 2 Changes of exercise duration after PCI according to pre-PCI functional and anatomical severity. (A) Pre-PCI Duke treadmill score and changes of exercise duration; (B) Pre-PCI SYNTAX score and changes in exercise duration. Correlation coefficient (beta) was adjusted for age, sex, hypertension, diabetes mellitus, previous percutaneous coronary intervention and previous myocardial infarction.PCI = percutaneous coronary intervention; SYNTAX = Synergy Between PCI With Taxus and Cardiac Surgery.

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  Figure 3 Comparison of risk of major adverse cardiac events at 3 years. Hazard ratio and its p value were adjusted for age, sex, hypertension, diabetes mellitus, previous percutaneous coronary intervention and previous myocardial infarction.CI = confidence interval; CR = complete revascularization; HRadj = adjusted hazard ratio; IR = incomplete revascularization.

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