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Published on: May 28, 2019
Prognostic Impact of a Routine Six-Month Exercise Stress Test after Complex Left Main Bifurcation Percutaneous
Gianluca Rigatelli1,2, Marco Zuin3, Giuseppe Marchese1
1Interventional Cardiology Unit, Division of Cardiology, Aulss6 Ospedali Riuniti Padova Sud, 35043 Monselice, Italy.
Insights
A negative exercise stress test after left main (LM) coronary artery stenting indicates better outcomes. Patients with negative tests experienced higher freedom from target lesion failure and improved survival rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- The prognostic value of exercise stress testing post-complex left main (LM) coronary artery bifurcation stenting is not well-established.
- Complex LM bifurcation disease requires advanced stenting techniques, with implications for long-term patient outcomes.
Purpose of the Study:
- To evaluate the prognostic impact of a 6-month post-intervention exercise stress test in patients undergoing complex LM bifurcation stenting.
- To determine if exercise stress test results correlate with long-term clinical outcomes, including target lesion failure (TLF), stent thrombosis, and cardiovascular mortality.
Main Methods:
- Retrospective analysis of 502 patients with complex LM bifurcation disease treated between January 2008 and May 2018.
- Patients underwent either single- or dual-stenting techniques, with exercise stress tests performed 6 months post-procedure.
- Clinical outcomes were assessed at a mean follow-up of 37.1 months.
Main Results:
- A positive exercise stress test was observed in 8.4% of patients, with a 7.6% incidence of significant restenosis.
- Patients with a negative exercise stress test demonstrated significantly higher freedom from TLF (10.1% overall rate).
- Improved survival rates were observed in patients with negative exercise stress test results compared to those with positive results.
Conclusions:
- Exercise stress testing at 6 months provides valuable prognostic information after complex LM bifurcation stenting.
- A negative exercise stress test is associated with better long-term outcomes, including reduced target lesion failure and improved survival.
- This non-invasive test can aid in risk stratification and patient management following complex coronary interventions.
Abstract:
The prognostic value of exercise stress test after complex left main (LM) coronary artery bifurcation (LM) stenting has been poorly investigated. To partially fill this gap in knowledge, we retrospectively analyzed the procedural and medical data of consecutive patients referred to our center for complex LM bifurcation disease between January 2008 and May 2018 who were treated using either single- or dual-stenting techniques. The prognostic impact of an exercise stress test, performed 6 months after the coronary intervention, was evaluated in 502 patients (316 males, mean age 70.3 ± 12.8 years, mean Syntax score 31.6 ± 6.3). At follow up after a mean of 37.1 ± 10.8 months (range 22.1-47.3 months), the target lesion failure (TLF) rate was 10.1% while stent thrombosis and cardiovascular mortality were 1.2 and 3.6%, respectively. A positive exercise stress test was detected at 6-month follow up in 42 out of 502 patients (8.4%); the incidence of a significant restenosis was 7.6% (n = 38). Patients with a negative exercise stress test at 6-month follow up had higher freedom from TLF and improved survival compared to those with a positive exercise stress test.
