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

Journal of Korean Medical Science 2020년 35권 27호 p.229 ~ 229
조성우, 양정훈, 박택규, 이주명, 송영빈, 한주용, 최진호, 권현철, 이상훈, 최승혁,
소속 상세정보
조성우 ( Cho Sung-Woo ) - Inje University College of Medicine Inje University Ilsan Paik Hospital Department of Internal Medicine
양정훈 ( Yang Jeong-Hoon ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
박택규 ( Park Taek-Kyu ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
이주명 ( Lee Joo-Myung ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
송영빈 ( Song Young-Bin ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
한주용 ( Hahn Joo-Yong ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
최진호 ( Choi Jin-Ho ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
권현철 ( Gwon Hyeon-Cheol ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
이상훈 ( Lee Sang-Hoon ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine
최승혁 ( Choi Seung-Hyuk ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Medicine

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.

키워드

Exercise Treadmill Testing; Percutaneous Coronary Intervention

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