Stress Testing–induced myocardial Ischemia not linked to 10 years CV events in stable CAD: JAMA

Stress testing–induced myocardial ischemia has no role in predicting cardiovascular events over 10 years in stable coronary artery disease (CAD) patients, revealed a study published in JAMA Internal Medicine.

Prior studies have proposed that the existence of myocardial ischemia during stress testing and outpatient electrocardiographic monitoring is associated with an enhanced danger of cardiac events.

This cohort study was undertaken by scientists at Mayo Clinic College of Medicine, using 10-year follow-up data from the Medicine, Angioplasty, or Surgery Study (MASS) II randomized clinical trial, 270 patients with stress-induced myocardial ischemia which showed similar rates of major adverse cardiovascular events and ventricular function changes compared with 265 patients without stress-induced ischemia.

Participants were previously randomized (May 1, 1995, to May 31, 2000) to medical therapy, percutaneous coronary intervention (PCI) with bare-metal stents, or coronary artery bypass grafting. Event-free survival was estimated by the Kaplan-Meier method, and multivariable Cox regression models were calculated to assess the association between ischemia and the primary composite endpoint. The vital status was determined on February 28, 2011. Data were analyzed from February 1, 2016, to April 1, 2017.

Key findings

• Of 611 participants, 535 underwent exercise stress testing at baseline: 270 with documented ischemia and 265 without.


• Of these 535 patients, 373 (69.7%) were men, and the mean age for the entire cohort was 59.7 (9.2) years.


• No association was found between the presence of ischemia at baseline and survival free of combined cardiovascular events after multivariable adjustment that included CAD initial randomized treatments.


• In addition, among 320 patients who underwent echocardiographic evaluation, the slight decline in left ventricular ejection fraction after 10 years was similar in both groups, respectively, for groups with and without ischemia.

Based on the findings, the authors wrote: " In this study, regardless of the therapeutic strategy applied, the presence of documented myocardial ischemia did not appear to be associated with an increased occurrence of major adverse cardiovascular events or changes in ventricular function in patients with multivessel CAD during a long-term follow-up."

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