Study examines exercise testing in asymptomatic patients after coronary revascularization

May 14, 2012 in Cardiology

Asymptomatic patients who undergo treadmill exercise echocardiography (ExE) after coronary revascularization may be identified as being at high risk but those patients do not appear to have more favorable outcomes with repeated revascularization, according to a report published Online First by Archives of Internal Medicine, a JAMA Network publication. The article is part of the journal's Less is More series.

Cardiac events and recurrent ischemia (a temporary shortage of oxygen caused by impaired blood flow; identified in the study as new or worsening cardiac wall motion abnormality shown on the echocardiogram) are common after , both (PCI) and coronary bypass graft surgery (CABG).

Guidelines of the American College of Cardiology/ recommend evaluation with stress imaging tests, including ExE, in symptomatic patients after revascularization, but evaluating "is more controversial," the authors note in the study background.

"Testing is considered inappropriate early after PCI (<2 years) and CABG (<5 years), but the justification for these cutoffs is ill defined," the study notes.

Serge C. Harb, M.D., and colleagues at the Cleveland Clinic Heart and Vascular Institute, Ohio, examined the effectiveness of testing asymptomatic patients early and late postrevascularization. Their observational study was conducted with data from asymptomatic patients with a history of PCI or CABG who were referred for ExE at the Cleveland Clinic from January 2000 through November 2010.

ExE was performed in 2,105 asymptomatic patients (average age 64; 310 were women; 845 [40 percent] had a history of [heart attack]; 1,143 [54 percent] had undergone PCI and 962 [46 percent] had undergone CABG an average of 4.1 years before the ExE).

Ischemia was detected in 262 patients and 88 of them underwent repeated revascularization. A total of 97 patients died over an average followup period of 5.7 years, and death was associated with ischemia in groups tested both early (less than two years after PCI or less than five years after CABG) and late (two or more years after PCI, or five or more years after CABG), according to the study results. The main predictor of outcome appeared to be exercise capacity, "suggesting that risk evaluation could be obtained from a standard exercise test rather than exercise echocardiography," the authors note.

"In conclusion, the results of this study suggest that asymptomatic patients who undergo treadmill ExE after coronary revascularization may be identified as being at high risk but do not seem to have more with RVs [repeated revascularization]," the authors conclude. "Given the very large population of post-PCI and post-CABG patients, careful consideration is warranted before the screening of asymptomatic patients is considered appropriate at any stage after revascularization."

In an invited commentary, Mark J. Eisenberg, M.D., M.P.H., of McGill University, Montreal, Canada, writes: "A strategy of routine periodic stress testing in asymptomatic patients following is associated with high rates of resource utilization and high costs. Most positive test results using such a strategy will be false-positives and will lead to further testing and additional angiographic procedures."

Eisenberg continues: "Despite the fact that current evidence discourages the use of routine testing, this strategy is still commonly observed in practice. Thus, the time has arrived for a large, well-controlled trial randomizing asymptomatic patients postrevascularization to routine periodic stress testing vs. conservative management."

"Until well-supported data become available supporting such a strategy, routine testing in asymptomatic patients is probably not worth the effort," Eisenberg concludes.

More information: Arch Intern Med. Published online May 14, 2012. doi:10.1001/archinternmed.2012.1355
Arch Intern Med. Published online May 14, 2012. doi:10.1001/archinternmed.2012.1910

Journal reference: JAMA Internal Medicine search and more info website

Provided by JAMA and Archives Journals search and more info website

not rated yet  

Rank not rated yet
Relevant PhysicsForums posts

More news stories

Study identifies superior hypertension treatment, efficacy between sexes

(Medical Xpress)—In a recent subgroup analysis of the largest blood pressure treatment trial in history, University of Alabama at Birmingham (UAB) researchers found that women and men react the same to ...

Cardiology created 2 hours ago | popularity 5 / 5 (1) | comments 0

Evaluating a new way to open clogged arteries

Over the past few decades, scientists have developed many devices that can reopen clogged arteries, including angioplasty balloons and metallic stents. While generally effective, each of these treatments ...

Cardiology created 3 hours ago | popularity 5 / 5 (2) | comments 0 | with audio podcast

Biomarker trio predicts near-term heart risk

(Medical Xpress)—Cardiologists have identified a trio of biomarkers that may predict which patients with heart disease have a high risk of heart attack or death in the next two years.

Cardiology created 4 hours ago | popularity not rated yet | comments 0 | with audio podcast

Hospitals' cardiac arrest incidence and survival rates go hand in hand

Hospitals with the highest rates of cardiac arrests tend to have the poorest survival rates for those cases, new University of Michigan Health System research shows.

Cardiology created 19 hours ago | popularity not rated yet | comments 0

Effect of fluid and sodium restrictions on weight loss among patients with heart failure

A clinical trial of 75 patients hospitalized with acute decompensated heart failure (ADHF) suggests that aggressive fluid and sodium restriction has no effect on weight loss or clinical stability at three days but was associated ...

Cardiology created 19 hours ago | popularity not rated yet | comments 0


Study shows where scene context happens in our brain

In a remote fishing community in Venezuela, a lone fisherman sits on a cliff overlooking the southern Caribbean Sea. This man –– the lookout –– is responsible for directing his comrades on the water, ...

Monoclonal antibody appears effective and safe in asthma Phase IIa trial

A novel approach to obstructing the runaway inflammatory response implicated in some types of asthma has shown promise in a Phase IIa clinical trial, according to U. S. researchers.

New rice contamination reported in China

Authorities are investigating rice mills in southern China following tests that found almost half of the staple grain in one of the country's largest cities was contaminated with a toxic metal.

Delayed transfer to the ICU increases risk of death in hospital patients

Delayed transfer to the intensive care unit (ICU) in hospitalized patients significantly increases the risk of dying in the hospital, according to a new study from researchers in Chicago.

New immune system discovered

(Medical Xpress)—A research team, led by Jeremy Barr, a biology post-doctoral fellow, unveils a new immune system that protects humans and animals from infection.

Genetic predictors of postpartum depression uncovered

Johns Hopkins researchers say they have discovered specific chemical alterations in two genes that, when present during pregnancy, reliably predict whether a woman will develop postpartum depression.