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

다국어 초록 (Multilingual 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.

참고문헌 (Reference)

1 Thygesen K, "Third universal definition of myocardial infarction" 33 : 2551-2567, 2012

2 Hung RK, "Prognostic value of exercise capacity in patients with coronary artery disease : the FIT(Henry Ford ExercIse Testing)project" 89 : 1644-1654, 2014

3 Mark DB, "Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease" 325 : 849-853, 1991

4 Choi KH, "Prognostic implication of functional incomplete revascularization and residual functional SYNTAX score in patients with coronary artery disease" 11 : 237-245, 2018

5 Al-Lamee R, "Percutaneous coronary intervention in stable angina(ORBITA) : a double-blind, randomised controlled trial" 391 : 31-40, 2018

6 Hambrecht R, "Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease : a randomized trial" 109 : 1371-1378, 2004

7 Tajima A, "Oxygen uptake kinetics during and after exercise are useful markers of coronary artery disease in patients with exercise electrocardiography suggesting myocardial ischemia" 73 : 1864-1870, 2009

8 Shaw LJ, "Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden : results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation(COURAGE)trial nuclear substudy" 117 : 1283-1291, 2008

9 Gehi AK, "Inducible ischemia and the risk of recurrent cardiovascular events in outpatients with stable coronary heart disease : the heart and soul study" 168 : 1423-1428, 2008

10 Hachamovitch R, "Impact of ischaemia and scar on the therapeutic benefit derived from myocardial revascularization vs. medical therapy among patients undergoing stress-rest myocardial perfusion scintigraphy" 32 : 1012-1024, 2011

11 Al-Lamee R, "Fractional flow reserve and instantaneous wave-free ratio as predictors of the placebo-controlled response to percutaneous coronary intervention in stable single-vessel coronary artery disease" 138 : 1780-1792, 2018

12 Xaplanteris P, "Five-year outcomes with PCI guided by fractional flow reserve" 379 : 250-259, 2018

13 Belardinelli R, "Exercise-induced myocardial ischaemia detected by cardiopulmonary exercise testing" 24 : 1304-1313, 2003

14 Fletcher GF, "Exercise standards for testing and training : a scientific statement from the American Heart Association" 128 : 873-934, 2013

15 Myers J, "Exercise capacity and mortality among men referred for exercise testing" 346 : 793-801, 2002

16 Nissen SE, "Effect of torcetrapib on the progression of coronary atherosclerosis" 356 : 1304-1316, 2007

17 Nissen SE, "Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure : the CAMELOT study : a randomized controlled trial" 292 : 2217-2225, 2004

18 Weintraub WS, "Effect of PCI on quality of life in patients with stable coronary disease" 359 : 677-687, 2008

19 Lele SS, "Determinants of exercise capacity in patients with coronary artery disease and mild to moderate systolic dysfunction. Role of heart rate and diastolic filling abnormalities" 17 : 204-212, 1996

20 Guazzi M, "Cardiopulmonary exercise testing: what is its value?" 70 : 1618-1636, 2017

21 Tonino PA, "Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation" 55 : 2816-2821, 2010

22 Hendel RC, "ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 appropriate use criteria for cardiac radionuclide imaging : a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine" 119 : e561-87, 2009

23 Parisi AF, "A comparison of angioplasty with medical therapy in the treatment of single-vessel coronary artery disease. Veterans affairs ACME investigators" 326 : 10-16, 1992

24 Choi BC, "A catalog of biases in questionnaires" 2 : A13-, 2005