Repeated Revascularization Doesn't Aid High-Risk Patients

Exercise testing after coronary revascularization may identify asymptomatic patients as high-risk

WEDNESDAY, May 16 (HealthDay News) -- For asymptomatic patients who are identified as high-risk by exercise echocardiography (ExE) after coronary revascularization, repeated revascularization is not associated with improved outcomes, according to a study published online May 14 in the Archives of Internal Medicine.

Serge C. Harb, M.D., from the Cleveland Clinic Heart and Vascular Institute, and colleagues studied 2,105 asymptomatic patients (mean age, 64 years; 15 percent women) who underwent ExE a mean of 4.1 years after percutaneous coronary intervention (PCI; 54 percent) or coronary artery bypass graft surgery (CABG; 46 percent). The correlation between survival and ischemia, defined as a new or worsening wall motion abnormality during ExE, was assessed, and the interaction with revascularization was investigated.

During a mean follow-up of 5.7 years, the researchers found that 262 patients had ischemia (13 percent), of which only 88 (34 percent) underwent revascularization. In groups tested early and late (≥2 years after PCI or ≥5 years after CABG), mortality (seen in 4.6 percent of patients) correlated with ischemia (hazard ratio, 2.10). Clinical and stress testing findings were better predictors of outcome than echocardiographic features. A positive test result or event was unlikely in asymptomatic patients without diabetes, with normal ejection fraction (≥50 percent) and normal exercise capacity (>6 metabolic equivalent for task). Repeated revascularization had no benefit even for high-risk patients.

"Asymptomatic patients who undergo ExE after coronary revascularization may be identified as being at high risk but do not seem to have more favorable outcomes with repeated revascularization," the authors write.

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