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Use of routine functional testing after percutaneous transluminal coronary angioplasty: results from the ROSETTA
M J Eisenberg1, D Schechter, J Lefkovits
1Jewish General Hospital, Montreal, Quebec, Canada.
Insights
Physicians often perform routine functional testing after percutaneous transluminal coronary angioplasty (PTCA), contrary to guidelines. Testing patterns varied significantly by medical center, not patient risk factors, indicating poor adherence to exercise testing recommendations.
Area of Science:
- Cardiology
- Clinical Practice Guidelines
- Medical Device Technology
Background:
- Current American College of Cardiology (ACC)/American Heart Association (AHA) guidelines recommend selective functional testing after percutaneous transluminal coronary angioplasty (PTCA) for high-risk patients only.
- Routine post-PTCA functional testing is suggested for detecting restenosis in specific patient groups.
Purpose of the Study:
- To document the utilization patterns of functional testing following PTCA.
- To determine if functional testing strategies align with patient clinical characteristics or physician preferences.
Main Methods:
- The Routine Versus Selective Exercise Treadmill Testing After Angioplasty (ROSETTA) Registry prospectively studied 788 patients across 13 centers in 5 countries.
- Data collection focused on the frequency, timing, and indications for functional testing post-PTCA.
Main Results:
- Nearly half of patients (49%) received functional testing within six months of successful PTCA, with significant center-to-center variation (10%-81%).
- A majority (61%) of tests were routine follow-up, not based on clinical indications (39%).
- Center location was the primary determinant for routine testing, overriding patient age and other clinical factors.
Conclusions:
- Physician adherence to ACC/AHA exercise testing guidelines for post-PTCA functional testing appears low.
- Clinical characteristics identified by guidelines did not influence routine testing decisions.
- The choice of functional testing strategy is predominantly dictated by the clinical center, not patient-specific risk.
Background:
The American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for exercise testing suggest that only selected groups of high-risk patients should undergo routine functional testing after percutaneous transluminal coronary angioplasty (PTCA) for the detection of restenosis.
Objectives:
Our purpose was (1) to document the patterns of use of post-PTCA functional testing and (2) to determine whether the choice of functional testing strategy is related to clinical characteristics of patients or whether physicians use a similar strategy for all their patients.
Methods:
The Routine Versus Selective Exercise Treadmill Testing After Angioplasty (ROSETTA) Registry is a prospective study examining the use of functional testing among 788 patients at 13 centers in 5 countries.
Results:
During the 6-month period after a successful PTCA, 49% of patients underwent functional testing (range among centers 10%-81%). Among patients who underwent functional testing, 39% had a clinical indication and 61% had functional testing as a routine follow-up. The first functional test was performed a median of 7 weeks after PTCA, with 13% of patients having second tests at a median of 14 weeks and 4% having additional tests at a median of 20 weeks. Univariate and multivariate analyses demonstrated that the chief determinant of the use of routine functional testing was clinical center. Aside from age (P <.0001), no baseline clinical or procedural characteristics were consistently associated with the use of routine functional testing after PTCA.
Conclusions:
Physicians do not appear to be adhering to the ACC/AHA guidelines for exercise testing regarding the routine use of post-PTCA functional testing. None of the clinical characteristics identified by the ACC/AHA guidelines were associated with the routine use of post-PTCA functional testing, and the primary determinant of functional testing was the location of the center at which the patient had the PTCA.
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