Routine stress testing after year of high-risk PCI of no added benefit: JAMA

In the management of patients with acute coronary syndrome (ACS) who have undergone high-risk percutaneous coronary intervention (PCI), a recent study published in the Journal of American Medical Association revealed that routine stress testing 12 months post-procedure does not offer additional benefits over the standard care.

The POST-PCI trial compared routine functional testing follow-up strategies with standard care alone. The patients were selected from 11 different sites in South Korea and recruited for this experiment between November 2017 and September 2019. Data analysis was carried out in 2022. 12 months following high-risk PCI, this study compared clinical outcomes between the two groups, one which underwent routine stress testing and other  group received standard care without routine testing. The primary measure from the study was a composite of death from any cause, myocardial infarction, or hospitalization for unstable angina within two years following randomization. 

The key findings of this study were:

The hazard ratio (HR) for the primary outcome in ACS patients was 1.55, with a 95% confidence interval (CI) of 1.03-2.33 and a P-value of .03. This elevated risk calls for the the critical need to effectively follow-up this patient group.

The mean age in the patient population was 64.7 (10.3) years, with 350 patients were female that accounted for 20.5%. Out of the 1706 patients, 526 individuals (30.8%) had ACS upon presentation. The patients with ACS had a 55% higher risk of the main outcome compared to those without ACS because of increased first-year incident rates.

In individuals with ACS and in patients without ACS, the 2-year occurrences of the main outcome were comparable whether using regular functional testing or standard therapy alone.

The formal relationships among ACS status and a combination of invasive angiography or repeat revascularization were not significant, despite a major study suggesting that the rates of invasive angiography and repeat revascularization were higher after 1 year in the regular functional testing group. At 12 months, regular monitoring and stress testing did not provide any additional benefit over standard care for ACS patients who had undergone high-risk PCI, despite their higher risk of serious complications in the first year following PCI.

Reference:

Lee, J., Kang, D.-Y., Kim, H., Choi, Y., Jo, S., Ahn, J.-M., Kim, S., Yoon, Y.-H., Hur, S.-H., Lee, C. H., Kim, W.-J., Kang, S. H., Park, C. S., Lee, B.-K., Suh, J.-W., Choi, J. W., Kim, K.-S., Lee, S. N., Park, S.-J., & Park, D.-W. (2024). Routine Stress Testing After PCI in Patients With and Without Acute Coronary Syndrome. In JAMA Cardiology. American Medical Association (AMA). https://doi.org/10.1001/jamacardio.2024.1556