Exercise Testing After PCI

Recurrent ischemia and cardiac events are common after PCI and CABG, signifying that coronary artery disease may still be progressing. Guidelines from the American College of Cardiology and the American Heart Association suggest evaluating symptomatic patients after these revascularization procedures with stress imaging tests, including exercise echocardiography (ExE). Evaluating asymptomatic patients, however, is more controversial. Testing is considered inappropriate less than 2 years after PCI and less than 5 years after CABG and of indeterminate appropriateness thereafter, but the justification for these cutoffs has not been well defined in clinical research. “Careful consideration is needed before screening asymptomatic patients at any stage after revascularization.” While the presence of ischemia on an ExE can help predict adverse outcomes after PCI and CABG, there is no evidence that repeated revascularization based on positive testing can change the course of the disease or patient outcomes. When noninvasive testing is used inappropriately, it can be costly to patients and the healthcare system. It can also lead to unnecessary downstream testing and interventions, such as coronary angiography and repeat revascularization. Testing Asymptomatic Patients After PCI & CABG In the May 14, 2012 Archives of Internal Medicine, my colleagues and I examined the effectiveness of testing asymptomatic patients early and late after revascularization using data from asymptomatic patients with a history of PCI or CABG who were referred for ExE. We looked at the frequency of a positive response, the association of test results with subsequent revascularization and mortality, and the presence of any interaction of revascularization with these event rates. ExE was performed in 2,105 asymptomatic patients, 54% of whom received PCI while 46%...