Utility of routine exercise treadmill testing early after percutaneous coronary intervention.
BACKGROUND
There have been few prospective studies examining the utility of routine exercise treadmill testing (ETT) early after percutaneous coronary intervention (PCI). The objective of this study was to examine the impact of a routine ETT strategy early after PCI on follow-up cardiac events and procedures.


METHODS
We examined 136 patients who underwent routine ETT at 6 weeks post-PCI in the ADORE trial. The ETT was classified as positive, indeterminate, or negative. The Duke Treadmill Score (DTS) was calculated for all patients. Follow-up occurred at 9 months.


RESULTS
ETT results at 6 weeks were: 32 (23.5%) positive, 24 (17.6%) indeterminate and 80 (58.8%) negative. At 9 months, the composite event rate was 21.9% in those with a positive ETT, 20.8% in those with an indeterminate ETT and 12.5% in those with a negative ETT (p = 0.25 positive vs. negative ETT). The sensitivity of early ETT for predicting clinical events was 41.2%, the specificity was 73.3%, the positive predictive value was 21.9% and the negative predictive value was 87.5%. At 9 months, the cardiac procedure rate was 18.8% in those with a positive test, 13.0% in those with an indeterminate test, and 6.3% in those with a negative test (p = 0.07 positive vs. negative ETT). In a multivariate logistic regression model, coronary stenting during PCI and a >/= 85% MPHR achieved were found to be inversely associated with clinical events. However, the DTS did not independently predict clinical events.


CONCLUSIONS
Although the statistical power of the study was limited by the small number of clinical events (particularly MI and death), the results of this study support the ACC/AHA guidelines that exercise treadmill testing should not be used routinely after PCI.
Babapulle
Mohan N
MN
Division of Cardiology, St. Mary's Regional Cardiac Care Centre Kitchener, Ontario, Canada. babapulle@gmail.com <babapulle@gmail.com>
Diodati
Jean G
JG
Blankenship
James C
JC
Huynh
Thao
T
Cugno
Sabrina
S
Puri
Radha
R
Nguyen
Phuong A
PA
Eisenberg
Mark J
MJ
D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000209:etiology; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D003327:Coronary Disease / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D023903:Coronary Restenosis / Q000175:diagnosis / Q000209:etiology; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome