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Published on: May 14, 2013

Exercise stress test results in patients with bare metal stents or drug-eluting stents: pathophysiological and

Roberto Nerla1, Antonio Di Monaco, Gregory A Sgueglia

  • 1Department of Cardiovascular Medicine, Catholic University of Sacred Heart.

Circulation Journal : Official Journal of the Japanese Circulation Society
|September 10, 2010
PubMed

Insights

Drug-eluting stents (DES) are linked to more positive exercise stress tests (EST) post-percutaneous coronary intervention (PCI) compared to bare metal stents (BMS). EST can predict clinical outcomes in stented coronary artery disease patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Research

Background:

  • Drug-eluting stents (DES) reduce restenosis after percutaneous coronary intervention (PCI) but may increase coronary endothelial dysfunction compared to bare metal stents (BMS).
  • Limited data exist on the prognostic value of exercise stress testing (EST) in PCI patients treated with DES.

Purpose of the Study:

  • To evaluate the prognostic value of exercise stress test (EST) in patients undergoing percutaneous coronary intervention (PCI) with either drug-eluting stents (DES) or bare metal stents (BMS).
  • To compare the rates of positive EST between DES and BMS groups and correlate EST results with clinical outcomes.

Main Methods:

  • A study of 160 patients with coronary artery disease (CAD) who received either BMS (n=86) or DES (n=74) for PCI.
  • Exercise stress test (EST) performed one month post-PCI.
  • Multivariate Cox-regression analysis to identify predictors of acute myocardial infarction (AMI) and target vessel revascularization (TVR).

Main Results:

  • Patients receiving DES showed a significantly higher rate of positive EST (49%) compared to BMS patients (32%; P=0.03).
  • At 18-month follow-up, DES demonstrated a trend towards lower target vessel revascularization (TVR) (HR 0.37) but a trend towards higher acute myocardial infarction (AMI) (HR 3.33).
  • Time to 1 mm ST depression and low-workload ischemia on EST were independent predictors of both AMI and TVR.

Conclusions:

  • DES implantation is associated with a higher incidence of positive EST one month post-PCI, potentially due to increased endothelial dysfunction.
  • Exercise stress testing (EST) appears valuable for predicting clinical outcomes in patients with coronary stents, including those treated with DES.
Abstract

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