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Six-month outcomes after single- and multi-lesion percutaneous coronary intervention: results from the ROSETTA
Lorne E Goldman1, Karen Okrainec, Mark J Eisenberg
1Jewish General Hospital, Montreal, Quebec.
Insights
Clinical outcomes after percutaneous coronary intervention (PCI) were similar for single- and multi-lesion procedures. Routine functional testing did not significantly benefit patients undergoing multi-lesion PCI, suggesting a need for further research in this area.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Guidelines suggest functional testing for high-risk restenosis patients post-percutaneous coronary intervention (PCI).
- Multi-lesion PCI patients are considered at higher risk for restenosis.
Purpose of the Study:
- Compare six-month clinical and procedural outcomes after single- versus multi-lesion PCI.
- Evaluate routine versus selective functional testing in multi-lesion PCI patients.
Main Methods:
- Prospective, multicentre ROSETTA registry enrollment.
- Examined six-month outcomes in 562 single-lesion and 229 multi-lesion PCI patients.
- Assessed routine functional testing versus selective testing in multi-lesion PCI.
Main Results:
- Similar rates of death, myocardial infarction, and composite endpoints between single- and multi-lesion PCI groups.
- Multi-lesion PCI patients had more repeat PCI procedures (13.4% vs 6.6%).
- Routine functional testing in multi-lesion PCI patients did not significantly reduce composite clinical events (OR 0.5, P=0.27).
Conclusions:
- Six-month clinical event rates were comparable for single- and multi-lesion PCI.
- Routine functional testing showed no statistically significant benefit for multi-lesion PCI patients.
- Further research is needed to define the role of routine functional testing in multi-lesion PCI.
Background:
The American College of Cardiology/American Heart Association exercise testing guidelines suggest that routine functional testing may benefit patients at high risk of restenosis, such as those undergoing multi-lesion percutaneous coronary intervention (PCI).
Objectives:
To compare the six-month post-PCI clinical and procedural outcomes in patients following single- and multi-lesion PCI, and to examine the use of routine functional testing (ie, in all patients) versus selective functional testing (ie, only in those with recurrent symptoms) following multi-lesion PCI.
Methods:
Six-month outcomes among 562 patients after single-lesion PCI and 229 patients after multi-lesion PCI were examined. All patients were enrolled in the Routine versus Selective Exercise Treadmill Testing after Angioplasty (ROSETTA) registry, a prospective, multicentre registry examining the use of functional testing after successful PCI.
Results:
For single- versus multi-lesion PCI patients, respectively, rates of death (1.8% versus 2.2%, P=0.7) and myocardial infarction (0.7% versus 2.6%, P=0.03) were low in both groups. Rates of unstable angina (12.0% versus 11.7%, P=0.9) and the composite clinical end point of death, myocardial infarction or unstable angina (13.5% versus 13.9%, P=0.9) were similar. Multi-lesion PCI patients had a higher number of repeat PCI procedures (6.6% versus 13.4%, P=0.02) but there was no difference in the rates of coronary artery bypass graft surgery (3.0% versus 2.6%, P=0.7). A routine functional testing strategy was used in 28.0% of single-lesion and 31.6% of multi-lesion patients. In a multivariate analysis of the multi-lesion patients, routine functional testing was not associated with a significant reduction in the composite clinical event rate (odds ratio 0.5, 95% CI 0.2 to 1.7, P=0.27).
Conclusions:
During the six-month period following successful PCI, clinical event rates were similar among patients undergoing single- or multi-lesion PCI. Routine functional testing was not associated with a statistically significant benefit in patients after multi-lesion PCI. However, additional study is required to better define the role of routine functional testing in this subgroup of patients.