Should CAD patients undergo routine functional testing after PCI?

Compared with standard care alone during follow-up, routine surveillance functional testing does not provide additional clinical benefits to high-risk patients with multivessel or left main coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI), reports a study.

In the POST-PCI* trial, the investigating team randomly assigned high-risk PCI patients to routine functional testing at 1 year or standard care alone during follow-up. The analysis centred on patients with multivessel or left main CAD. A composite of death from any cause, myocardial infarction, or hospitalization for unstable angina at 2 years was the primary outcome.

Of the 1,706 initially randomized patients, 1,192 had multivessel (n=833) or left main (n=359) CAD, among whom 589 were in the functional testing group and 603 in the standard care group.

At 2 years, the incidences of the primary outcome did not significantly differ between the two arms (6.2 percent vs 5.7 percent, respectively; hazard ratio [HR], 1.09, 95 percent confidence interval [CI], 0.68‒1.74; p=0.73). Such a trend persisted in both multivessel (6.2 percent vs 5.7 percent; HR, 1.09, 95 percent CI, 0.62‒1.89; p=0.78) and left main CAD (6.2 percent vs 5.7 percent; HR, 1.09, 95 percent CI, 0.46‒2.56; p=0.85; p_interaction=0.90).

In addition, routine surveillance functional testing appeared to result in higher rates of invasive angiography and repeat revascularization beyond 1 year.

*Pragmatic Trial Comparing Symptom-Oriented Versus Routine Stress Testing in High-Risk Patients Undergoing Percutaneous Coronary Intervention