Author + information
Despite recommendation of practice guidelines, noninvasive stress tests prior to revascularization are performed in only minority of patients undergoing percutaneous coronary intervention (PCI). This study aimed to determine impact of noninvasive stress tests prior to elective PCI on clinical outcomes in patients with stable ischemic heart disease (SIHD) in the drug-eluting stent (DES) era.
We studied consecutive 3208 patients undergoing elective PCI using drug-eluting stents for SIHD. Patients were divided into 2 groups: the Test group underwent noninvasive stress test within 180 days prior to PCI (n=1202); and the Non-test group did not (n=2006). The primary outcome was a composite of death or myocardial infarction (MI) at 5 years after the index procedure.
In the Test group, treadmill test was performed in 570 patients, exercise echocardiography in 398 patients, myocardial perfusion imaging in 272 patients and other test in 29 patients. Patients undergoing stress tests were younger and had a higher prevalence of male patients, but a lower prevalence of previous MI and revascularization than those not undergoing stress tests. Angiographic characteristics were similar between the 2 groups. Over 5 years after the index PCI, the risk of death or MI was lower in the Test group than in the Non-test group (7.1% versus 11.0%, adjusted HR 0.71, 95% CI 0.54-0.94, p=0.02). The incidence of any revascularization was not different between two groups (16.8% versus 16.8%, adjusted HR 1.01, 95% CI 0.83-1.21, p=0.94). After propensity score matching with 1202 well-matched pairs of patients, the incidence of death or MI was still significantly lower in the Test group than in the Non-test group (7.1% versus 10.0%, HR 0.69, 95% CI 0.51-0.92, p=0.01).
Noninvasive stress tests prior to elective PCI were associated with a reduced risk of death or MI. Our data suggest that preprocedural noninvasive stress tests may improve long-term clinical outcomes in patients with SIHD.
CORONARY: PCI Outcomes