Exercise Testing After Bypass or Percutaneous Coronary Intervention

  • Grant Fowler
  • Michael Altman

Coronary artery bypass graft (CABG) surgery continues to be performed for patients with coronary artery disease (CAD), especially those with symptomaticmulti-vessel disease and diabetes. Percutaneous coronary intervention (PCI) is not only used to treat patients with symptoms from CAD, but has also become the treatment of choice for patients with destabilized coronary plaque, whether they present with acute myocardial infarction (ST or non-ST elevation MI) or unstable angina. PCI is also being used formulti-vessel CAD.


Primary Care Clinician Stable Coronary Artery Disease Radionuclide Imaging Noncardiac Surgery Cardiac Rehabilitation Program 
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  1. 1.
    BARI Investigators: Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. N Engl J Med. 1996 Jul 25; 335(4):217–25Google Scholar
  2. 2.
    Kurbaan AS, Bowker TJ, Ilsley CD, Rickards AF. Impact of postangioplasty restenosis on comparisons of outcome between angioplasty and bypass grafting. Coronary Angioplasty versus Bypass Revascularisation Investigation (CABRI) Investigators. Am J Cardiol. 1998 Aug 1; 82(3):272–76PubMedCrossRefGoogle Scholar
  3. 3.
    Henderson RA, Pocock SJ, Sharp SJ, Nanchahal K, Sculpher MJ, Buxton MJ, Hampton JR. Long-term results of RITA-1 trial: clinical and cost comparisons of coronary angioplasty and coronary-artery bypass grafting. Randomised Intervention Treatment of Angina. Lancet 1998 Oct 31; 352(9138):1419–25Google Scholar
  4. 4.
    King SB 3rd, Barnhart HX, Kosinski AS, et al. Angioplasty or surgery for multivessel coronary artery disease: comparison of eligible registry and randomized patients in the EAST trial and influence of treatment selection on outcomes. Emory Angioplasty versus Surgery Trial Investigators. Am J Cardiol. 1997 Jun 1; 79(11):1453–9PubMedCrossRefGoogle Scholar
  5. 5.
    Rupprecht HJ, Hamm C, Ischinger T, Dietz U, Reimers J, Meyer J. Angiographic follow-up results of a randomized study on angioplasty versus bypass surgery (GABI trial). GABI Study Group. Eur Heart J. 1996 Aug; 17(8):1192–8Google Scholar
  6. 6.
    Carrié D, Elbaz M, Puel J, Fourcade J, Karouny E, Fournial G, Galinier M. Five-year outcome after coronary angioplasty versus bypass surgery in multivessel coronary artery disease: results from the French Monocentric Study. Circulation 1997 Nov 4;96(9 Suppl):II-1–6PubMedGoogle Scholar
  7. 7.
    Urban P, Stauffer JC, Bleed D, Khatchatrian N, Amann W, Bertel O, van den Brand M, Danchin N, Kaufmann U, Meier B, Machecourt J, Pfisterer M. A randomized evaluation of early revascularization to treat shock complicating acute myocardial infarction. The (Swiss) Multicenter Trial of Angioplasty for Shock-(S)MASH. Eur Heart J. 1999 Jul; 20(14):1030–8PubMedCrossRefGoogle Scholar
  8. 8.
    Dagres N, Erbel R. [Comparison between PTCA and bypass operation. Results of large randomized studies]. Med Klin (Munich). 1998 Jan 15; 93(1):22– 6, 58CrossRefGoogle Scholar
  9. 9.
    Rodriguez AE, Baldi J, Fernández Pereira C, Navia J, Rodriguez Alemparte M, Delacasa A, Vigo F, Vogel D, O’Neill W, Palacios IF, ERACI II Investigators. Five-year follow-up of the Argentine randomized trial of coronary angioplasty with stenting versus coronary bypass surgery in patients with multiple vessel disease (ERACI II). J Am Coll Cardiol. 2005 Aug 16; 46(4):582–8PubMedCrossRefGoogle Scholar
  10. 10.
    Serruys PW, Ong AT, van Herwerden LA, Sousa JE, Jatene A, Bonnier JJ, Schönberger JP, Buller N, Bonser R, Disco C, Backx B, Hugenholtz PG, Firth BG, Unger F. Five-year outcomes after coronary stenting versus bypass surgery for the treatment of multivessel disease: the final analysis of the Arterial Revascularization Therapies Study (ARTS) randomized trial. J Am Coll Cardiol. 2005 Aug 16; 46(4):575–81PubMedCrossRefGoogle Scholar
  11. 11.
    Zhang Z, Mahoney EM, Spertus JA, Booth J, Nugara F, Kolm P, Stables RH, Weintraub WS. The impact of age on outcomes after coronary artery bypass surgery versus stent-assisted percutaneous coronary intervention: one-year results from the Stent or Surgery (SoS) trial. Am Heart J. 2006 Dec; 152(6):1153–60PubMedCrossRefGoogle Scholar
  12. 12.
    Eagle KA, Berger PB, Calkins\enlargethispage{6pt} H, et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery—executive summary a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation 2002 Mar 12; 105(10):1257–67PubMedGoogle Scholar
  13. 13.
    Dori G, Denekamp Y, Fishman S, Bitterman H. Exercise stress testing, myocardial perfusion imaging and stress echocardiography for detecting restenosis after successful percutaneous transluminal coronary angioplasty: a review of performance. J Intern Med. 2003 Mar; 253(3):253–62PubMedCrossRefGoogle Scholar
  14. 14.
    Garzon PP, Eisenberg MJ. Functional testing for the detection of restenosis after percutaneous transluminal coronary angioplasty: a meta-analysis. Can J Cardiol. 2001 Jan; 17(1):41–8Google Scholar
  15. 15.
    BARI Investigators. The final 10-year follow-up results from the BARI randomized trial. J Am Coll Cardiol. 2007 Apr 17; 49(15):1600–6. Epub 2007 Apr 2Google Scholar
  16. 16.
    Krone RJ, Hardison RM, Chaitman BR, Gibbons RJ, Sopko G, Bach R, Detre KM. Risk stratification after successful coronary revascularization: the lack of a role for routine exercise testing. J Am Coll Cardiol. 2001 Jul; 38(1):136–42PubMedCrossRefGoogle Scholar
  17. 17.
    Snader CE, Marwick TH, Pashkow FJ, Harvey SA, Thomas JD, Lauer MS. Importance of estimated functional capacity as a predictor of all-cause mortality among patients referred for exercise thallium single-photon emission computed tomography: report of 3,400 patients from a single center. J Am Coll Cardiol. 1997 Sep; 30(3):641–8PubMedCrossRefGoogle Scholar
  18. 18.
    Stratmann HG, Tamesis BR, Younis LT, Wittry MD, Miller DD. Prognostic value of dipyridamole technetium-99m sestamibi myocardial tomography in patients with stable chest pain who are unable to exercise. Am J Cardiol. 1994 Apr 1; 73(9):647–52PubMedCrossRefGoogle Scholar
  19. 19.
    Pollock SG, Abbott RD, Boucher CA, Beller GA, Kaul S. Independent and incremental prognostic value of tests performed in hierarchical order to evaluate patients with suspected coronary artery disease. Validation of models based on these tests. Circulation 1992 Jan; 85(1): 237–48PubMedGoogle Scholar
  20. 20.
    Chin AS, Goldman LE, Eisenberg MJ. Functional testing after coronary artery bypass graft surgery: a meta-analysis. Can J Cardiol. 2003 Jun; 19(7):802–8PubMedGoogle Scholar
  21. 21.
    Diaz LA, Brunken RC, Blackstone EH, Snader CE, Lauer MS. Independent contribution of myocardial perfusion defects to exercise capacity and heart rate recovery for prediction of all-cause mortality in patients with known or suspected coronary heart disease. J Am Coll Cardiol. 2001 May; 37(6):1558–64PubMedCrossRefGoogle Scholar
  22. Froelicher VF. Miscellaneous applications of exercise testing. In Exercise and the Heart (5th edition), Froelicher VF, Myers J (eds.). Philadelphia: Elsevier, 2006Google Scholar
  23. 23.
    Waller BF, Rothbaum DA, Gorfinkel HJ, Ulbright TM, Linnemeier TJ, Berger SM. Morphologic observations after percutaneous transluminal balloon angioplasty of early and late aortocoronary saphenous vein bypass grafts. J Am Coll Cardiol. 1984 Oct; 4(4):784–92PubMedCrossRefGoogle Scholar
  24. 24.
    Neitzel GF, Barboriak JJ, Pintar K, Qureshi I. Atherosclerosis in aortocoronary bypass grafts. Morphologic study and risk factor analysis 6 to 12 years after surgery. Arteriosclerosis 1986 Nov–Dec; 6(6):594–600Google Scholar
  25. 25.
    Walts AE, Fishbein MC, Sustaita H, Matloff JM. Ruptured atheromatous plaques in saphenous vein coronary artery bypass grafts: a mechanism of acute, thrombotic, late graft occlusion. Circulation 1982 Jan; 65(1):197–201PubMedGoogle Scholar
  26. 26.
    Tilli FV, Kaplan BM, Safian RD, et al. Angioscopic plaque friability: a new risk factor for procedural complications following saphenous vein graft interventions (abstract). J Am Coll Cardiol. 1996;27(Suppl A):364ACrossRefGoogle Scholar
  27. 27.
    Sommerhaug RG, Wolfe SF, Reid DA, Lindsey DE. Improved stress test results after multiple coronary grafting. Am J Surg. 1985 May; 149(5):583–6PubMedCrossRefGoogle Scholar
  28. 28.
    Ellestad MH. Stress testing after surgical intervention and coronary angioplasty. In Stress Testing: Principals and Practice (5th edition), Ellestad MH (ed.). New York: Oxford, 2003Google Scholar
  29. 29.
    Grondin CM, Campeau L, Thornton JC, Engle JC, Cross FS, Schreiber H. Coronary artery bypass grafting with saphenous vein. Circulation 1989 Jun;79(6 Pt 2):I24–9PubMedGoogle Scholar
  30. 30.
    ROSETTA-CABG Registry, Eisenberg MJ, Wou K, Nguyen H, Duerr R, Del Core M, Fourchy D, et al. Lack of benefit for routine functional testing early after coronary artery bypass graft surgery: results from the ROSETTA-CABG Registry. J Invasive Cardiol. 2006 Apr; 18(4): 147–52PubMedGoogle Scholar
  31. 31.
    Gohlke H, Gohlke-Börwolf C, Samek L, Stürzenofecker P, Schmuziger M, Roskamm H. Serial exercise testing up to 6 years after coronary bypass surgery: behavior of exercise parameters in groups with different degrees of revascularization determined by postoperative angiography. Am J Cardiol. 1983 May 1; 51(8):1301–6PubMedCrossRefGoogle Scholar
  32. 32.
    Guttin J. Longitudinal evaluation of patients after coronary artery bypass by serial treadmill testing. Am J Cardiol. 1975 35:142CrossRefGoogle Scholar
  33. 33.
    Lakkis NM, Mahmarian JJ, Verani MS. Exercise thallium-201 single photon emission computed tomography for evaluation of coronary artery bypass graft patency. Am J Cardiol. 1995 Jul 15; 76(3):107–11PubMedCrossRefGoogle Scholar
  34. 34.
    Sakamoto Y, Takakura H, Saitoh F, Ohnishi K, Shiratori K, Takagi K, Ikei H, Kurosawa H. Assessment of coronary artery bypass surgery by exercise thallium imaging. Ann Thorac Cardiovasc Surg. 1999 Dec; 5(6):387–90PubMedGoogle Scholar
  35. 35.
    Shapira I, Heller I, Kornizky Y, Topilsky M, Isakov A. The value of stress thallium-201 single photon emission CT imaging as a predictor of outcome and long-term prognosis after CABG. J Med. 2001; 32(5–6):271–82PubMedGoogle Scholar
  36. 36.
    Zellweger MJ, Lewin HC, Lai S, Dubois EA, Friedman JD, Germano G, Kang X, Sharir T, Berman DS. When to stress patients after coronary artery bypass surgery? Risk stratification in patients early and late post-CABG using stress myocardial perfusion SPECT: implications of appropriate clinical strategies. J Am Coll Cardiol. 2001 Jan; 37(1):144–52PubMedCrossRefGoogle Scholar
  37. 37.
    Lauer MS, Ellis S. Is routine functional testing after coronary bypass surgery worthwhile? J Invasive Cardiol. 2006 Apr; 18(4):153–4PubMedGoogle Scholar
  38. 38.
    Kawachi Y, Nakashima A, Toshima Y, Komesu I, Kimura S, Arinaga K. Risk stratification analysis of operative mortality in coronary artery bypass surgery. Jpn J Thorac Cardiovasc Surg. 2001 Sep; 49(9):557–63PubMedCrossRefGoogle Scholar
  39. 39.
    Nallamothu N, Johnson JH, Bagheri B, et al. Utility of stress single-photon emission computed tomography (SPECT) perfusion imaging in predicting outcome after coronary artery bypass grafting. Am J Cardiol. 1997 Dec 15; 80(12):1517–21PubMedCrossRefGoogle Scholar
  40. 40.
    Miller TD, Christian TF, Hodge DO, Mullan BP, Gibbons RJ. Prognostic value of exercise thallium-201 imaging performed within 2 years of coronary artery bypass graft surgery. J Am Coll Cardiol. 1998 Mar 15; 31(4):848–54PubMedCrossRefGoogle Scholar
  41. 41.
    Houslay ES, Lawton T, Sengupta A, Uren NG, McKillop G, Newby DE. Non-invasive assessment of coronary artery bypass graft patency using 16-slice computed tomography angiography. J Cardiothorac Surg. 2007 Jun 5;2:27Google Scholar
  42. 42.
    Chirillo F, Bruni A, De Leo A, Olivari Z, Franceschini-Grisolia E, Totis O, Stritoni P. Usefulness of dipyridamole stress echocardiography for predicting graft patency after coronary artery bypass grafting. Am J Cardiol. 2004 Jan 1; 93(1):24–30PubMedCrossRefGoogle Scholar
  43. 43.
    Qarawani D, Nahir M, Abboud M, et al. Culprit only versus complete coronary revascularization during primary PCI. Int J Cardiol. 2008 Jan 24; 123(3):288–92PubMedCrossRefGoogle Scholar
  44. 44.
    Boden WE, O’Rourke RA, Teo KK, et al., COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007 Apr 12; 356(15):1503–16. Epub 2007 Mar 26PubMedCrossRefGoogle Scholar
  45. 45.
    Hochman JS, Lamas GA, Buller CE, et al., Occluded Artery Trial Investigators. Coronary intervention for persistent occlusion after myocardial infarction. N Engl J Med. 2006 Dec 7; 355(23):2395–407. Epub 2006 Nov 14PubMedCrossRefGoogle Scholar
  46. 46.
    Moreno R, Fernandez C, Hernandez R, Alfonso F, Angiolillo DJ, Sabate M, Escaned J, Banuelos C, Fernandez-Ortiz A, Macaya C. Drug-eluting stent thrombosis: results from a pooled analysis including 10 randomized studies. J Am Coll Cardiol. 2005 Mar 15;45(6):954–9PubMedCrossRefGoogle Scholar
  47. 47.
    Bavry AA, Kumbhani DJ, Helton TJ, Bhatt DL. Risk of thrombosis with the use of sirolimus-eluting stents for percutaneous coronary intervention (from registry and clinical trial data). Am J Cardiol. 2005 Jun 15; 95(12):1469–72PubMedCrossRefGoogle Scholar
  48. 48.
    Bavry AA, Kumbhani DJ, Helton TJ, Bhatt DL. What is the risk of stent thrombosis associated with the use of paclitaxel-eluting stents for percutaneous coronary intervention? a meta-analysis. J Am Coll Cardiol. 2005 Mar 15; 45(6):941–6PubMedCrossRefGoogle Scholar
  49. 49.
    Eisenberg MJ, Wilson B, Lauzon C, Huynh T, Eisenhauer M, Mak KH, Blankenship JC, Doucet M, Pilote L, ADORE II Investigators. Routine functional testing after percutaneous coronary intervention: results of the aggressive diagnosis of restenosis in high-risk patients (ADORE II) trial. Acta Cardiol. 2007 Apr; 62(2):143–50PubMedCrossRefGoogle Scholar
  50. 50.
    Valeur N, Clemmensen P, Saunamaki K, Grande P, DANAMI-2 Investigators. The prognostic value of pre-discharge exercise testing after myocardial infarction treated with either primary PCI or fibrinolysis: a DANAMI-2 sub-study. Eur Heart J. 2005 Jan; 26(2):119–27. Epub 2004 Dec 6PubMedCrossRefGoogle Scholar
  51. 51.
    Ho KT, Miller TD, Holmes DR, Hodge DO, Gibbons RJ. Long-term prognostic value of Duke treadmill score and exercise thallium-201 imaging performed one to three years after percutaneous transluminal coronary angioplasty. Am J Cardiol. 1999 Dec 1; 84(11):1323–7PubMedCrossRefGoogle Scholar
  52. 52.
    Rajagopal V, Lauer MS. Nuclear imaging in patients with a history of coronary revascularization. In Clinical Nuclear Cardiology: State of the Art and Future Directions (3rd edition), Zaret BL, Beller GA (eds.). Philadelphia: Elsevier, 2004Google Scholar
  53. 53.
    Acampa W, Petretta M, Florimonte L, Mattera A, Cuocolo A. Prognostic value of exercise cardiac tomography performed late after percutaneous coronary intervention in symptomatic and symptom-free patients. Am J Cardiol. 2003 Feb 1; 91(3):259–63PubMedCrossRefGoogle Scholar
  54. 54.
    Acampa W, Evangelista L, Petretta M, Liuzzi R, Cuocolo A. Usefulness of stress cardiac single-photon emission computed tomographic imaging late after percutaneous coronary intervention for assessing cardiac events and time to such events. Am J Cardiol. 2007 Aug 1; 100(3):436–41. Epub 2007 Jun 13PubMedCrossRefGoogle Scholar
  55. 55.
    Mak KH, Eisenberg MJ, Tsang J, Okrainiec K, Huynh T, Brown DL, ROSETTA Investigators. Clinical impact of functional testing strategy among stented and non-stented patients: insights from the ROSETTA Registry. Int J Cardiol. 2004 Jun; 95(2–3):321–7PubMedCrossRefGoogle Scholar
  56. 56.
    Saririan M, Cugno S, Blankenship J, Huynh T, Sedlis S, Starling M, Pilote L, Wilson B,Eisenberg MJ. Routine versus selective functional testing after percutaneous coronary intervention in patients with diabetes mellitus. J Invasive Cardiol. 2005 Jan; 17(1):25–9PubMedGoogle Scholar
  57. 57.
    Cademartiri F, Palumbo A, Maffei E, La Grutta L, Runza G, Pugliese F, Midiri M, Mollet NR, Meijboom WB, Menozzi A, Vignali L, Reverberi C, Ardissino D, Krestin GP. Radiol Med (Torino). Diagnostic accuracy of 64-slice CT in the assessment of coronary stents. 2007 Jun; 112(4):526–37. Epub 2007 Jun 11Google Scholar
  58. 58.
    Hirata K, Watanabe H, Otsuka R, et al. Noninvasive diagnosis of restenosis by transthoracic Doppler echocardiography after percutaneous coronary intervention: comparison with exercise TI-SPECT. J Am Soc Echocardiogr. 2006 Feb; 19(2):165–71PubMedCrossRefGoogle Scholar
  59. 59.
    Elhendy A, Tsutsui JM, O’Leary EL, Xie F, Majeed F, Porter TR. Evaluation of restenosis and extent of coronary artery disease in patients with previous percutaneous coronary interventions by dobutamine stress real-time myocardial contrast perfusion imaging. Heart 2006 Oct; 92(10):1480–3. Epub 2006 Apr 10PubMedCrossRefGoogle Scholar
  60. 60.
    Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation 2002 Oct 1; 106(14):1883–92PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Grant Fowler
    • 1
  • Michael Altman
    • 2
  1. 1.Department of Family and Community MedicineThe University of Texas Health Science Center HoustonHoustonUSA
  2. 2.Department of Family MedicineUniversity of Texas Health Science CenterHoustonUSA

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