Journal Article

Role of routine surveillance stress testing in patients with or without imaging-guided or physiology-guided PCI

Suh, Jung-Won, Lee, Su Nam, Choi, Yeonwoo, Lee, Jinho, Kim, Hoyun, Park, Chul-Su, Jo, Sangyong, Kim, Kee-Sik, Ahn, Jung-Min, Kang, Se Hun, Kim, Nayoung, Kim, Won-Jang, Choi, Jae Woong, Yoon, Yong-Hoon, Kang, Do-Yoon, Park, Seung-Jung, Lee, Cheol Hyun, Lee, Bong-Ki, Park, Duk-Woo, Hur, Seung-Ho

2025

Overview

ObjectiveThe optimal follow-up strategy for high-risk patients who underwent imaging-guided or physiology-guided percutaneous coronary intervention (PCI) remains uncertain. We investigated whether routine surveillance stress testing after PCI provides clinical benefit when the procedure is guided by intravascular ultrasonography (IVUS) or fractional flow reserve (FFR).MethodsIn the Pragmatic Trial Comparing Symptom-Oriented vs Routine Stress Testing in High-Risk Patients Undergoing PCI randomised trial, 1706 high-risk patients who underwent PCI were assigned to either routine functional testing at 1 year or standard care alone. In this prespecified subgroup analysis, patients were subsequently categorised according to whether IVUS or FFR was used at the index procedure. The primary outcome was a composite of death, myocardial infarction or hospitalisation for unstable angina over 2 years.ResultsAmong the randomised population, 74% underwent IVUS-guided intervention and 36% underwent FFR-guided intervention. At 2 years, rates of the primary outcome were similar between routine testing and standard care both in patients treated with IVUS guidance (5.3% vs 6.7%; HR 0.79; 95% CI 0.50 to 1.24) and without IVUS guidance (5.7% vs 3.8%; HR 1.52; 95% CI 0.63 to 3.68; interaction p=0.21). Comparable results were observed in patients with FFR guidance (2.6% vs 3.9%; HR 0.65; 95% CI 0.26 to 1.58) and without FFR guidance (7.0% vs 7.1%; HR 0.99; 95% CI 0.63 to 1.55; interaction p=0.59). Routine functional testing was consistently associated with higher use of invasive coronary angiography and repeat revascularisation, without improvement in clinical outcomes.ConclusionsAmong high-risk patients who underwent PCI, routine surveillance stress testing did not reduce the risk of death, myocardial infarction or unstable angina, regardless of the use of IVUS or FFR at the index procedure. Routine functional testing increased downstream invasive procedures without clinical benefit. These findings support guideline recommendations against routine surveillance testing after PCI.Trial registration numberNCT03217877.

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ Publishing Group LTD
• Subject: Angioplasty / Cardiac stress tests / Clinical outcomes / Coronary Angiography / Coronary artery disease / Diabetes / Hospitalization / Ischemia / Medical imaging / Patients / Percutaneous Coronary Intervention / Physiology / Surveillance / Ultrasonic imaging