May 15th, 2012

No Benefit Found for Exercise Echocardiography in Asymptomatic Patients Following CABG Or PCI

Routine exercise echocardiography in asymptomatic patients after revascularization does not lead to better outcomes, according to a new study published in Archives of Internal Medicine. Although guidelines generally discourage the practice, post-revascularization stress tests are still commonly performed.

Serge Harb and colleagues performed exercise echocardiography on 2105 patients after CABG surgery or PCI and followed them for a mean of 5.7 years. Some 13% of the subjects were found to have ischemia; of these, one third underwent repeat revascularization. Nearly half (49%) of the patients without ischemia on the initial test underwent further exercise testing. Overall, 17% of patients in the study underwent repeat revascularization. However, revascularization had no significant impact on mortality.

Mortality was higher in patients who had ischemia at any time than in patients with no ischemia (8% vs. 4.1%, p=0.03). However, the authors reported that “clinical and stress testing findings, but not echocardiographic features, were associated with both all-cause and cardiac mortality.” This finding, according to the authors, suggests “that risk evaluation could be obtained from a standard exercise test rather than exercise echocardiography.”

The authors write that “careful consideration is warranted before the screening of asymptomatic patients is considered appropriate at any stage after revascularization.”

In an accompanying commentary, Mark Eisenberg writes that the study makes “a compelling argument that routine periodic stress testing in asymptomatic patients following coronary revascularization is of little clinical benefit.”

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