Key result
Routine surveillance stress testing after PCI shows no benefit over standard care for major events.
Why the study?
The optimal follow-up strategy for high-risk patients who undergo imaging-guided or physiology-guided PCI remains uncertain, specifically whether routine surveillance stress testing provides clinical benefit after IVUS- or FFR-guided PCI.
Does routine functional testing at 1 year reduce the composite of death, myocardial infarction, or hospitalization for unstable angina in high-risk patients who underwent PCI?
RCT (n=1,706)
randomised
Does routine functional testing at 1 year reduce the composite of death, myocardial infarction, or hospitalization for unstable angina in high-risk patients who underwent PCI?
Effect estimate: HR 0.79 (95% CI 0.50-1.24)
Absolute Event Rate: 5.3% vs 6.7%
Routine surveillance stress testing after PCI does not improve clinical outcomes in high-risk patients, regardless of whether IVUS or FFR was used during the index procedure, but increases downstream invasive procedures.
Routine post-PCI surveillance stress testing should not be routine; challenges presumed outcome benefits regardless of IVUS/FFR.
OBJECTIVE: The optimal follow-up strategy for high-risk patients who underwent imaging-guided or physiology-guided percutaneous coronary intervention (PCI) remains uncertain. We investigated whether routine surveillance stress testing after PCI provides clinical benefit when the procedure is guided by intravascular ultrasonography (IVUS) or fractional flow reserve (FFR). METHODS: In the Pragmatic Trial Comparing Symptom-Oriented vs Routine Stress Testing in High-Risk Patients Undergoing PCI randomised trial, 1706 high-risk patients who underwent PCI were assigned to either routine functional testing at 1 year or standard care alone. In this prespecified subgroup analysis, patients were subsequently categorised according to whether IVUS or FFR was used at the index procedure. The primary outcome was a composite of death, myocardial infarction or hospitalisation for unstable angina over 2 years. RESULTS: Among the randomised population, 74% underwent IVUS-guided intervention and 36% underwent FFR-guided intervention. At 2 years, rates of the primary outcome were similar between routine testing and standard care both in patients treated with IVUS guidance (5.3% vs 6.7%; HR 0.79; 95% CI 0.50 to 1.24) and without IVUS guidance (5.7% vs 3.8%; HR 1.52; 95% CI 0.63 to 3.68; interaction p=0.21). Comparable results were observed in patients with FFR guidance (2.6% vs 3.9%; HR 0.65; 95% CI 0.26 to 1.58) and without FFR guidance (7.0% vs 7.1%; HR 0.99; 95% CI 0.63 to 1.55; interaction p=0.59). Routine functional testing was consistently associated with higher use of invasive coronary angiography and repeat revascularisation, without improvement in clinical outcomes. CONCLUSIONS: Among high-risk patients who underwent PCI, routine surveillance stress testing did not reduce the risk of death, myocardial infarction or unstable angina, regardless of the use of IVUS or FFR at the index procedure. Routine functional testing increased downstream invasive procedures without clinical benefit. These findings support guideline recommendations against routine surveillance testing after PCI. TRIAL REGISTRATION NUMBER: NCT03217877.
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Choi et al. (2025) conducted an RCT in High-risk patients who underwent PCI (n=1,706). Routine functional testing vs. Standard care alone was evaluated on Composite of death, myocardial infarction or hospitalisation for unstable angina over 2 years (IVUS-guided subgroup) (HR 0.79, 95% CI 0.50-1.24). Routine surveillance stress testing after PCI did not reduce the 2-year risk of death, MI, or unstable angina compared to standard care, regardless of IVUS or FFR guidance.
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