Results of a routine exercise treadmill testing strategy early after percutaneous transluminal coronary angioplasty

BACKGROUND: Some physicians use routine exercise tread mill testing early a fter percutaneous transluminal coronary angioplasty (PTCA), yet there have been few prospective studies examining the results of such a functional tes ting strategy. OBJECTIVES: To examine the results of a routine post-PTCA exercise treadmil l testing strategy and to explore the impact of such a strategy on follow-u p functional tests and cardiac procedures . PATIENTS AND METHODS: Functional test results were examined from a cohort o f 226 patients who underwent PTCA at a single institution in which a routin e functional testing strategy is used. Tests were defined as 'routine' if t hey were performed solely because the patient had a Frier PTCA. Tests were defined as 'selective' if they were done for a clinical indication or if th ere was no functional testing during the six-month follow-up. RESULTS: A total oi 183 patients (81%) underwent at least one functional te st during the six-month period after PTCA. Of these patients, 150 (82%) und erwent routine functional testing, the majority (73%) of which were exercis e treadmill tests. Sixty-seven per cent of patients who had routine functio nal testing had their first functional test less than seven weeks after the ir PTCA. Most routine exercise treadmill test were found to be electrically or clinically indeterminate (46%, but a substantial number were either ele ctrically or clinically positive (28%), or electrically and clinically nega tive (39%). Of patients who had electrically or clinically positive routine tests, 57% had repeat functional testing and 23% had repeat revascularisat ion. Of patients who had electrically and clinically negative tests, 53% ha d repeat functional testing and 10% had repeat revascularization. Of the pa tients who had electrically or clinically indeterminate tests, 53% had repe at functional testing and 14% had repeat revascularization. The rate of cli nical events was less than 4%, irrespective of the results of the exercise treadmill tests. CONCLUSIONS: Routine exercise treadmill testing early after PTCA is associa ted with a low clinical yield. Most routine exercise treadmill testing resu lts in indeterminate and negative tests, which often lead to more functiona l tests with little difference in clinical outcome. These results call into question the use of a routine post-PTCA functional testing strategy.