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Although current guideline recommendations do not recommend routine functional testing for patients who have undergone percutaneous coronary intervention (PCI), many physicians follow such patients with serial testing. In this industry-supported, multicenter study in Korea (NCT03217877, investigators randomly assigned 1706 patients immediately after PCI to undergo stress testing (electrocardiography, echocardiography, or nuclear imaging) at 1 year or receive standard care and examined a primary composite outcome of death, myocardial infarction, or hospitalization for unstable angina at 2 years.
All patients had high-risk anatomic or clinical characteristics, including left main disease (21%), bifurcation lesions (44%), multivessel disease (70%), diffuse long lesions (70%), or diabetes (39%). The mean age of participants was 65 years, and 80% were men. At 2 years, the primary outcome occurred in 5.5% of the functional-testing group and 6.0% of the standard-care group, a nonsignificant difference. The individual components of the primary outcome also did not differ between groups. There were trends toward more angiograms and repeat revascularizations in the testing group between 1 and 2 years. About 5% of patients died or underwent invasive angiography before the 1-year testing.
Park D-W et al. Routine functional testing or standard care in high-risk patients after PCI. N Engl J Med 2022 Aug 28; [e-pub]. (https://doi.org/10.1056/NEJMoa2208335)
Comment
Consistent with current guidelines, this randomized trial confirms that routine functional testing 1 year after PCI, as compared with standard care, did not reduce ischemic cardiovascular events or death in high-risk patients. The low number of women in this study may limit the generalizability. In my practice, I recommend testing infrequently after PCI to assess for residual ischemia or to guide exercise recommendations. In addition, all patients should be referred for cardiac rehabilitation after PCI, which may require stress testing or include monitored exercise. Whether such evaluations might reduce adverse events within 1 year of PCI for high-risk patients will require further study.