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ORIGINAL INVESTIGATION LESS IS MORE Exercise Testing in Asymptomatic Patients After Revascularization Are Outcomes Altered? Serge C. Harb, MD; Thomas Cook, MPH, PhD; Wael A. Jaber, MD; Thomas H. Marwick, MD, PhD, MPH Background: Although exercise echocardiography (ExE) Results: Of 262 patients with ischemia (13%), only 88 of asymptomatic patients early (2 years after percuta- (34%) underwent subsequent revascularization. Mortal- ity (97 patients [4.6%]) was associated with ischemia (haz- neous coronary intervention [PCI] or5 years after coro- ard ratio, 2.10; 95% CI, 1.05-4.19; P=.04) in groups tested nary bypass graft surgery [CABG]) after revasculariza- both early (P=.03) and late (2 years after PCI or 5 tion is considered inappropriate, the appropriateness of years after CABG) (P=.001). However, the main predic- later testing is indeterminate. Treatment responses to posi- tors of outcome were clinical and stress testing findings tive test results in either setting have uncertain outcome rather than echocardiographic features. Subgroup analy- implications. We sought to identify whether predictors sis showed that asymptomatic patients without diabetes of increased risk by ExE could lead to interventions that mellitus, with normal ejection fraction (50%), and nor- change outcome in asymptomatic patients with previ- mal exercise capacity (6 METs [metabolic equivalent
JAMA Internal Medicine – American Medical Association
Published: Jun 11, 2012
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