Surveillance Stress Testing After Percutaneous Intervention for Patients With Multivessel or Left Main Coronary
Joong Min Lee1, Hoyun Kim1, Young-Sun Park1
1Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Routine functional testing after percutaneous coronary intervention (PCI) offers no additional benefit for high-risk patients with multivessel or left main coronary artery disease (CAD). This approach did not improve outcomes but increased invasive procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Optimal surveillance post-percutaneous coronary intervention (PCI) for high-risk patients with multivessel or left main coronary artery disease (CAD) is not well-defined.
- Current guidelines lack consensus on routine functional testing versus standard care in this patient population.
Purpose of the Study:
- To evaluate the prognostic value of routine functional testing in high-risk patients with multivessel or left main CAD after PCI.
- To compare the clinical outcomes of routine functional testing versus standard care during follow-up.
Main Methods:
- The Pragmatic Trial Comparing Symptom-Oriented Versus Routine Stress Testing in High-Risk Patients Undergoing Percutaneous Coronary Intervention (POST-PCI) trial randomized patients.
- High-risk PCI patients were assigned to either routine functional testing at 1 year or standard care.
- The primary outcome was a composite of all-cause death, myocardial infarction, or unstable angina hospitalization at 2 years.
Main Results:
- Among 1,192 patients with multivessel or left main CAD, 2-year primary outcome rates were similar between routine functional testing (6.2%) and standard care (5.7%) groups (HR: 1.09; P=0.73).
- No significant difference was observed in multivessel (6.2% vs 5.7%) or left main disease (6.2% vs 5.7%) subgroups.
- Routine testing led to increased invasive angiography and repeat revascularization rates beyond 1 year.
Conclusions:
- Routine surveillance functional testing provides no incremental clinical benefit for high-risk patients with multivessel or left main CAD post-PCI compared to standard care.
- The POST-PCI trial indicates that symptom-oriented follow-up may be sufficient, avoiding unnecessary invasive procedures.
Background:
The optimal surveillance strategy after percutaneous coronary intervention (PCI) for high-risk patients with multivessel or left main coronary artery disease (CAD) remains uncertain.
Objectives:
This study aims to determine the prognostic role of routine functional testing in patients with multivessel or left main CAD who underwent PCI.
Methods:
The POST-PCI (Pragmatic Trial Comparing Symptom-Oriented Versus Routine Stress Testing in High-Risk Patients Undergoing Percutaneous Coronary Intervention) trial randomized high-risk PCI patients to routine functional testing at 1 year or standard care alone during follow-up. This analysis focused on participants with multivessel or left main CAD. The primary outcome was a composite of death from any cause, myocardial infarction, or hospitalization for unstable angina at 2 years.
Results:
Among 1,706 initially randomized patients, 1,192 patients with multivessel (n = 833) or left main (n = 359) were identified, with 589 in the functional testing group and 603 in the standard care group. Two-year incidences of primary outcome were similar between the functional testing group and the standard care group (6.2% vs 5.7%, respectively; HR: 1.09; 95% CI: 0.68-1.74; P = 0.73). This trend persisted in both groups of multivessel (6.2% vs 5.7%; HR: 1.09; 95% CI: 0.62-1.89; P = 0.78) and left main disease (6.2% vs 5.7%; HR: 1.09; 95% CI: 0.46-2.56; P = 0.85) (P for interaction = 0.90). Routine surveillance functional testing was associated with increased rates of invasive angiography and repeat revascularization beyond 1 year.
Conclusions:
In high-risk patients with multivessel or left main CAD who underwent PCI, there was no incremental clinical benefit from routine surveillance functional-testing compared with standard care alone during follow-up. (Pragmatic Trial Comparing Symptom-Oriented Versus Routine Stress Testing in High-Risk Patients Undergoing Percutaneous Coronary Intervention [POST-PCI]; NCT03217877).
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