Risk stratification after successful coronary revascularization: The lack of a role for routine exercise testing

OBJECTIVE The objective of this study was to evaluate the American College of Cardiology/American Heart Association (ACC/AHA) guidelines fur exercise testing (EXT) after successful coronary revascularization (CR) using the Bypass Angioplasty Revascularization Investigation experience. BACKGROUND The ACC/AHA guidelines state that EXT within three years of successful CR is not useful. METHODS The 1,678 patients randomized to CR by tither angioplasty or bypass surgery were required to take symptom-limited treadmill tests one, three and five years after revascularization. RESULTS Patients who took the test at each specified time had a much lower subsequent two-year mortality than those who did not (1.9% vs. 9.4%, 3.5% vs. 12.6% and 3.3% vs. 11.0% at one, three and five years, respectively, after CR [p < 0.0001 for each]). Exercise parameters at the one- and three-year test did not improve a multivariable model of survival after including clinical parameters. Exercising to Bruce stage 3 or generating a Duke score >-6 were independently predictive of two-year survival after the five-year test. ST depression on the one-year test was associated with more revascularizations (relative risk = 1.6; p < 0.001). CONCLUSIONS Patients with stable multivessel coronary disease who rook a protocol-mandated. exercise test at one, three and five years after revascularization were at low risk for mortality in the two years subsequent to each test. Exercise parameters did not improve prediction of mortality in the two years after the one- and three-year tests. The ACC/AHA guidelines on exercise testing after CR (no value for routine testing in stable patients for three years after revascularization) are supported by these results. (J Am Coll Cardiol 2001.;38: 136-42) (C) 2001 by the American College of Cardiology.