Key result
Preprocedural exercise stress testing was associated with a significantly reduced risk of all-cause death or nonfatal myocardial infarction at 5 years compared to no prior stress testing (HR 0.34).
Why the study?
It is unknown whether antecedent exercise stress testing affects long-term outcomes in patients undergoing elective PCI for stable ischemic heart disease.
Does a preprocedural exercise stress test improve long-term outcomes in patients undergoing elective PCI for stable ischemic heart disease?
Cohort (n=2,674)
No
Does a preprocedural exercise stress test improve long-term outcomes in patients undergoing elective PCI for stable ischemic heart disease?
Hazard Ratio: 0.34 (95% CI 0.22–0.55)
Absolute Event Rate: 3.3% vs 10.9%
p-value: p=<0.001
Performing an exercise stress test prior to elective PCI for stable ischemic heart disease is associated with a significantly lower long-term risk of all-cause death or myocardial infarction.
Supports preprocedural exercise stress testing before elective PCI; extends risk stratification evidence in stable ischemic heart disease.
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).
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Kim et al. (2019) conducted a cohort in Stable ischemic heart disease (SIHD) (n=2,674). Preprocedural exercise stress test (EST) vs. No noninvasive stress tests prior to PCI was evaluated on Composite of all-cause death or nonfatal myocardial infarction (MI) at 5 years (HR 0.34, 95% CI 0.22-0.55, p=<0.001). Preprocedural exercise stress testing was associated with a significantly reduced risk of all-cause death or nonfatal myocardial infarction at 5 years compared to no prior stress testing (HR 0.34).
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