Exercise stress test results in patients with bare metal stents or drug-eluting stents: pathophysiological and clinical implications.
BACKGROUND
Drug-eluting stents (DES) have reduced restenosis following percutaneous coronary intervention (PCI), but they seem to be associated with increased coronary endothelial dysfunction compared to bare metal stents (BMS). No data are available about the prognostic value of exercise stress test (EST) in PCI patients in the DES era.


RESULTS
The 160 patients with coronary artery disease (CAD) who underwent PCI with either BMS (n=86) or DES (n=74) were studied. EST was performed 1 month after PCI. DES patients had a higher rate of positive EST compared to BMS patients (49% vs 32%; P=0.03). At a median follow-up of 18 months DES showed a lower rate of target vessel revascularization (TVR) (hazard ratio (HR) 0.37, P=0.07), but a higher rate of acute myocardial infarction (AMI) (HR 3.33, P=0.08). At multivariate Cox-regression time to 1 mm ST and low-workload ischemia were independent predictors of AMI (HR 0.96, P=0.03; and HR 6.24, P=0.009, respectively), as well as of TVR (HR 0.96, P=0.007; and HR 6.43, P=0.001, respectively).


CONCLUSIONS
DES implantation is associated with a higher rate of positive EST, compared to BMS, 1 month after PCI, likely due to a higher prevalence of endothelial dysfunction. EST seems to be helpful in predicting clinical outcome in patients with coronary stent implantation.
Nerla
Roberto
R
Department of Cardiovascular Medicine, Catholic University of Sacred Heart.
Di Monaco
Antonio
A
Sgueglia
Gregory A
GA
Battipaglia
Irma
I
Careri
Giulia
G
Pinnacchio
Gaetano
G
Tarzia
Pierpaolo
P
Lanza
Gaetano Antonio
GA
Crea
Filippo
F
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000628:therapy*; D003331:Coronary Vessels / Q000503:physiopathology; D054855:Drug-Eluting Stents; D004730:Endothelium, Vascular / Q000503:physiopathology; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
D008670:Metals