Wenaweser Peter, Surmely Jean-François, Windecker Stephan, Roffi Marco, Togni Mario, Billinger Michael, Cook Stephane, Vogel Rolf, Seiler Christian, Hess Otto M, Meier Bernhard
Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
Am J Cardiol. 2008 Mar 15;101(6):807-11. doi: 10.1016/j.amjcard.2007.10.046. Epub 2008 Jan 14.
The clinical value of early exercise stress testing (EST) after coronary stenting to predict long-term clinical outcomes is unknown. Of 1,000 unselected patients who underwent coronary stenting, 446 random patients underwent early EST the day after intervention. Clinical long-term outcomes (41 +/- 20 months) were correlated with normal (n = 314 [70%]) or positive (n = 102 [23%]) EST results. Patients with inconclusive test results (n = 30 [7%]) were excluded from the analysis. Overall mortality was significantly higher in patients with positive EST results (9.3% vs 3.9%, p = 0.04). Major adverse cardiac events and cardiac mortality also tended to be higher in patients with positive stress test results (45.4% vs 35.4%, p = 0.08, and 4.1% vs 1.1%, p = 0.05, respectively). Patients with the combination of positive stress test results and incomplete revascularization appeared to be the group at highest risk for major adverse cardiac events (47.1% vs 33.3% for patients with normal stress test results and complete revascularization, p = NS). Negative stress test results reduced (odds ratio 0.329, 95% confidence interval 0.120 to 0.905, p = 0.031) and a lower ejection fraction increased (odds ratio 0.942, 95% confidence interval 0.897 to 0.989, p = 0.017) the risk for death. In conclusion, an early stress test after coronary stenting provides important prognostic information. Positive stress test results, especially in combination with incomplete revascularization, are associated with higher mortality, a trend toward more repeat revascularization procedures, and higher risk for major adverse cardiac events.
冠状动脉支架置入术后早期运动负荷试验（EST）预测长期临床结局的临床价值尚不清楚。在1000例接受冠状动脉支架置入术的未经过筛选的患者中，446例随机患者在干预后第二天接受了早期EST。临床长期结局（41±20个月）与EST结果正常（n = 314 [70%]）或阳性（n = 102 [23%]）相关。试验结果不确定的患者（n = 30 [7%]）被排除在分析之外。EST结果阳性的患者总体死亡率显著更高（9.3%对3.9%，p = 0.04）。应激试验结果阳性的患者发生主要不良心脏事件和心脏死亡的几率也往往更高（分别为45.4%对35.4%，p = 0.08，以及4.1%对1.1%，p = 0.05）。应激试验结果阳性且血运重建不完全的患者似乎是发生主要不良心脏事件风险最高的群体（应激试验结果正常且血运重建完全的患者为47.1%对33.3%，p =无统计学意义）。应激试验结果阴性降低了死亡风险（比值比0.329，95%置信区间0.120至0.905，p = 0.031），而较低的射血分数增加了死亡风险（比值比0.942，95%置信区间0.897至0.989，p = 0.017）。总之，冠状动脉支架置入术后早期应激试验可提供重要的预后信息。应激试验结果阳性，尤其是与血运重建不完全相结合时，与更高的死亡率、更多重复血运重建手术的趋势以及主要不良心脏事件的更高风险相关。
