Percutaneous coronary revascularization is associated with higher exercise capacity after myocardial infarction
Gorgis S, Demertzis Z, Malette K, Fram G, Dobesh K, Keteyian S, Alaswad K, Basir M, and Brawner C. Percutaneous coronary revascularization is associated with higher exercise capacity after myocardial infarction. Journal of the American College of Cardiology 2020; 75(11):220.
J Am Coll Cardiol
Background Cardiopulmonary exercise testing (CPET) is a valuable tool to assess exercise tolerance and prognosis in heart failure. Limited studies have evaluated its clinical utility in patients with myocardial infarction (MI). The purpose of this study was to evaluate exercise capacity in post-MI patients based on whether they received percutaneous coronary intervention (PCI) or were treated with medical therapy. Methods We retrospectively identified patients who completed a CPET within 1 year after an acute MI. A general linear mixed model was developed to compare peak oxygen uptake (VO2) between patients who did and did not receive PCI with adjustments for age, sex, ST-elevation MI (STEMI), and presence of chronic total occlusion (CTO). A sub-analysis was performed in patients with CTO. Results Between April 2002 and March 2019, 436 patients (age= 57±11 years; 65% male; 63% white; 40% STEMI; 30% CTO; 70% PCI) completed a CPET within 1 year post-MI. Among 175 patients who suffered a STEMI, 84% underwent PCI. Among 261 patients who suffered a non-STEMI, 61% underwent PCI. There was significant variability of PCI performed between sex, race, MI type, and age (P<0.05). As shown in the Table, PCI was associated with significantly higher adjusted peak VO2 among the entire cohort and the subgroup of patients with CTO (n=130). Conclusion Among patients who suffer an acute MI, PCI is associated with higher exercise capacity as determined by peak VO2. This effect was larger in patients who present with CTO.