Journal Article

Routine Functional Testing or Standard Care in High-Risk Patients after PCI

Suh, Jung-Won, Lee, Su Nam, Yoon, Jung Han, Yun, Sung-Cheol, Kim, Kee-Sik, Choi, Si Wan, Ahn, Jung-Min, Kang, Se Hun, 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, Park, Chul Soo

2022

Overview

There are limited data from randomized trials to guide a specific follow-up surveillance approach after myocardial revascularization. Whether a follow-up strategy that includes routine functional testing improves clinical outcomes among high-risk patients who have undergone percutaneous coronary intervention (PCI) is uncertain. We randomly assigned 1706 patients with high-risk anatomical or clinical characteristics who had undergone PCI to a follow-up strategy of routine functional testing (nuclear stress testing, exercise electrocardiography, or stress echocardiography) at 1 year after PCI or to standard care alone. The primary outcome was a composite of death from any cause, myocardial infarction, or hospitalization for unstable angina at 2 years. Key secondary outcomes included invasive coronary angiography and repeat revascularization. The mean age of the patients was 64.7 years, 21.0% had left main disease, 43.5% had bifurcation disease, 69.8% had multivessel disease, 70.1% had diffuse long lesions, 38.7% had diabetes, and 96.4% had been treated with drug-eluting stents. At 2 years, a primary-outcome event had occurred in 46 of 849 patients (Kaplan-Meier estimate, 5.5%) in the functional-testing group and in 51 of 857 (Kaplan-Meier estimate, 6.0%) in the standard-care group (hazard ratio, 0.90; 95% confidence interval [CI], 0.61 to 1.35; P = 0.62). There were no between-group differences with respect to the components of the primary outcome. At 2 years, 12.3% of the patients in the functional-testing group and 9.3% in the standard-care group had undergone invasive coronary angiography (difference, 2.99 percentage points; 95% CI, -0.01 to 5.99), and 8.1% and 5.8% of patients, respectively, had undergone repeat revascularization (difference, 2.23 percentage points; 95% CI, -0.22 to 4.68). Among high-risk patients who had undergone PCI, a follow-up strategy of routine functional testing, as compared with standard care alone, did not improve clinical outcomes at 2 years. (Funded by the CardioVascular Research Foundation and Daewoong Pharmaceutical; POST-PCI ClinicalTrials.gov number, NCT03217877.).

• Publisher: Massachusetts Medical Society
• Subject: Aftercare / Angina / Angiography / Angioplasty / Cardiology / Cardiology General / Cardiovascular disease / Clinical outcomes / Clinical trials / Coronary Artery Bypass - adverse effects / Coronary Artery Disease - diagnosis / Coronary Artery Disease - diagnostic imaging / Coronary Artery Disease - therapy / Coronary Disease / Coronary vessels / Design / Diabetes / Diabetes mellitus / Diagnostic Tests, Routine / Disease prevention / Drug delivery / Drug-Eluting Stents - adverse effects / Echocardiography / EKG / Electrocardiography / Heart attacks / Hospitalization / Humans / Implants / Ischemia / Kaplan-Meier Estimate / Medical imaging / Middle Aged / Myocardial Infarction / Myocardial Infarction - etiology / Patient safety / Patients / Percutaneous Coronary Intervention - adverse effects / Percutaneous Coronary Intervention - methods / Prevention / Risk groups / Standard of Care / Stents / Treatment Outcome / Vein & artery diseases