J Korean Med Sci.  2020 Jul;35(27):e229. 10.3346/jkms.2020.35.e229.

Clinical Implications of Early Exercise Treadmill Testing after Percutaneous Coronary Intervention in the Drug-eluting Stent Era

• Cho SW
• Yang JH
• Park TK
• Lee JM
• Song YB
• Hahn JY
• Choi JH
• Gwon HC
• Lee SH
• Choi SH

• KMID: 2504264
• DOI: http://doi.org/10.3346/jkms.2020.35.e229

Abstract

Background
Limited data are available on the clinical meaning of early routine exercise treadmill testing (ETT) after percutaneous coronary intervention (PCI) in the drug-eluting stent era. We aimed to determine the clinical utility and implications of early routine ETT after PCI.
Methods
This was a single-center, prospective cohort study. A total of 776 patients underwent ETT within 3 months after index PCI were analyzed. We classified patients into ETT positive (+) and negative (−) groups and compared major adverse cardiac events (MACE) including all-cause death, myocardial infarction, and coronary revascularization.
Results
The median follow-up duration was 19.6 months (interquartile range, 15.4 to 33.5 months). ETT was positive for 63 patients (17.1%) with single-vessel disease (VD) and 150 patients (36.9%) with multi-VD. Previous PCI, absence of thrombotic lesion, multi-VD, and residual Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score > 8 were independent predictors of ETT (+). Compared with the ETT (−) group, the ETT (+) group was associated with increased risk of MACE for patients with single-VD (18.1% vs. 52.3%; adjusted hazard ratio [HR], 2.67; 95% confidence interval [CI], 1.10–6.49; P = 0.03) and residual SYNTAX score ≤ 8 (26.5% vs. 42.1%; adjusted HR, 1.90; 95% CI, 1.09–3.30; P = 0.02), but not for patients with multi-VD and residual SYNTAX score > 8.
Conclusion
Early routine ETT after PCI might be helpful for predicting clinical outcomes in patients with single-VD and residual SYNTAX score ≤ 8 but not multi-VD and residual SYNTAX score > 8.

Keyword

Exercise Treadmill Testing; Percutaneous Coronary Intervention

Figure

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  Fig. 1 Study design and population.ETT = exercise treadmill testing, PCI = percutaneous coronary intervention, VD = vessel disease, MACE = major adverse cardiac events, MI = myocardial infarction.

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  Fig. 2 Kaplan-Meier curves for MACE according to ETT (−) and ETT (+) groups. (A) single-VD and (B) multi-VD.MACE = major adverse cardiac events, ETT = exercise treadmill testing, VD = vessel disease.

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  Fig. 3 Kaplan-Meier curves for MACE according to ETT (−) and ETT (+) groups. (A) residual SYNTAX score ≤ 8, or (B) > 8.MACE = major adverse cardiac events, ETT = exercise treadmill testing, PCI = percutaneous coronary intervention, SYNTAX = Synergy Between PCI With Taxus and Cardiac Surgery.

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