Abstract 15044: Prognostic Value of Exercise Stress Testing in Patients With Multivessel Coronary Disease Undergoing Medicine, Angioplasty or Surgery: 10-year Follow-Up of the Mass II Trial
BACKGROUND: Exercise stress testing (EST) is used routinely to estimate prognosis of patients with coronary artery disease (CAD). We evaluated the relation of ischemic EST with arterial pattern and occurrence of adverse events in patients with CAD submitted to coronary bypass surgery (CABG), percutaneous coronary intervention (PCI) and medical therapy alone (MT) as a post-hoc analysis of a randomized controlled trial with a follow-up of 10 years.
METHODS: EST was performed in patients with stable multivessel CAD participants of MASS II trial before randomization to CABG, PCI, or MT. Stress-induced ischemia (SII) was considered present when exertional angina developed and/or documentation of ST ischemic changes. The relation of SII with the primary composite endpoint (overall mortality, Q-wave myocardial infarction, or refractory angina that required revascularization) and arterial pattern was analyzed.
RESULTS: Of the 611 participants of MASS II trial, 535 performed EST at baseline: 176 patients from MT, 179 from CABG and 180 from PCI. There was no difference of arterial pattern among patients with or without SII (113 of 224 with double vessel and 157 of 311 patients with triple vessel disease had SII, P=0.943; 243 of 481 and 27 of 54 patients respectively with and without proximal left anterior descending coronary artery involvement presented SII, P=0.784). Among patients with SII, those in CABG group evolved less often with the primary composite endpoint compared to PCI and MT groups (79 of 81, 46 of 98 and 75 of 91 patients respectively for MT, RM and PCI; P=0.003). Additionally, patients without SII in CABG group had less adverse events than PCI and MT groups (84 of 95, 39 of 81 and 70 of 89 patients respectively for MT, CABG and PCI;P= 0.0001).
CONCLUSION: The presence of ischemic changes in EST at baseline was not associated with coronary pattern severity and occurrence of adverse events in MASS II trial.
- © 2013 by American Heart Association, Inc.