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Lack of association of exercise testing with coronary stent closure

      The possibility that an exercise tolerance test (ETT) could be hazardous to patients who have undergone intravascular procedures was suggested by case reports of acute coronary thrombosis at percutaneous transluminal coronary angioplasty sites after exercise testing,
      • Przybojewski J.
      • Weich H.
      Acute coronary thrombus formation after stress testing following percutaneous transluminal coronary angioplasty. A case report.
      ,
      • Goodman S.
      • Holloway R.
      • Adelman A.
      Acute coronary thrombotic occlusion following exercise testing 6 weeks after percutaneous transluminal coronary angioplasty.
      ,
      • Dash H.
      Delayed coronary occlusion after successful percutaneous transluminal coronary angioplasty.
      and later by 2 case reports in patients who had undergone coronary stenting. Samuels et al
      • Samuels B.
      • Schumann J.
      • Kiat H.
      • Friedman J.
      • Berman D.
      Acute stent thrombosis associated with exercise testing after successful percutaneous transluminal coronary angioplasty.
      reported that a patient had an acute coronary thrombosis after an ETT performed 5 days after coronary arterial stenting, and Maraj et al
      • Maraj R.
      • Fraifeld M.
      • Owen A.N.
      • Kotler M.N.
      • Yazdanfar S.
      Coronary dissection and thrombosis associated with exercise testing three months after successful coronary stenting.
      reported that a 76-year-old man had coronary dissection and stent thrombosis 20 minutes after completion of a normal exercise test performed 3 months after deployment of 5 stents. However, these may have been isolated events, and the actual risk (if any) of abrupt closure resulting from poststent exercise testing is not known. We report our experience at the Brigham and Women’s Hospital with early exercise testing between May 1996 and December 1998 as a demonstration that the procedure seemed to be safe in 261 patients referred for an ETT within 60 days after coronary arterial stent implantation. The patients were consecutive patients who had exercise testing, but only 261 of the 2,105 patients who had stents also had an ETT. The decision for performing an ETT was made by the attending physician for the purpose of assessing the state of coronary circulation, and was more likely to be performed in patients who were symptomatic. We have no way of knowing whether selection factors for these tests led to the testing of patients who were less vulnerable to complications; because patients were more likely to be symptomatic, it seems unlikely that the least vulnerable were selected.
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      References

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