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PubMed · 41043864

Role of routine surveillance stress testing in patients with or without imaging-guided or physiology-guided PCI.

Yeonwoo Choi·Do-Yoon Kang·Hoyun Kim·Jinho Lee·Sangyong Jo·Jung-Min Ahn·Nayoung Kim·Yong-Hoon Yoon·Seung-Ho Hur·Cheol Hyun Lee·Won-Jang Kim·Se Hun Kang·Chul-Su Park·Bong-Ki Lee·Jung-Won Suh·Jae Woong Choi·Kee-Sik Kim·Su Nam Lee·Seung-Jung Park·Duk-Woo Park·POST-PCI Investigators
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Abstract

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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HumansPercutaneous Coronary InterventionFemaleUltrasonography, InterventionalMaleFractional Flow Reserve, MyocardialCoronary Artery DiseaseAgedExercise TestMiddle AgedCoronary AngiographyMyocardial InfarctionTreatment OutcomePredictive Value of TestsAngina, UnstableRisk FactorsClinical RelevanceJournal ArticleRandomized Controlled TrialPragmatic Clinical TrialMulticenter StudyComparative StudyResearch Support, Non-U.S. Gov't

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Yeonwoo Choi, Do-Yoon Kang, Hoyun Kim, Jinho Lee, Sangyong Jo, Jung-Min Ahn, Nayoung Kim, Yong-Hoon Yoon, Seung-Ho Hur, Cheol Hyun Lee, Won-Jang Kim, Se Hun Kang, Chul-Su Park, Bong-Ki Lee, Jung-Won Suh, Jae Woong Choi, Kee-Sik Kim, Su Nam Lee, Seung-Jung Park, Duk-Woo Park, POST-PCI Investigators. 2026-09-11. Role of routine surveillance stress testing in patients with or without imaging-guided or physiology-guided PCI.. https://doi.org/10.1136/heartjnl-2025-326402

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