Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Am Coll Cardiol. 2024 Mar 5;83(9):890-900. doi: 10.1016/j.jacc.2023.12.027.
The optimal surveillance strategy after percutaneous coronary intervention (PCI) for high-risk patients with multivessel or left main coronary artery disease (CAD) remains uncertain.
This study aims to determine the prognostic role of routine functional testing in patients with multivessel or left main CAD who underwent PCI.
The POST-PCI (Pragmatic Trial Comparing Symptom-Oriented Versus Routine Stress Testing in High-Risk Patients Undergoing Percutaneous Coronary Intervention) trial randomized high-risk PCI patients to routine functional testing at 1 year or standard care alone during follow-up. This analysis focused on participants with multivessel or left main CAD. The primary outcome was a composite of death from any cause, myocardial infarction, or hospitalization for unstable angina at 2 years.
Among 1,706 initially randomized patients, 1,192 patients with multivessel (n = 833) or left main (n = 359) were identified, with 589 in the functional testing group and 603 in the standard care group. Two-year incidences of primary outcome were similar between the functional testing group and the standard care group (6.2% vs 5.7%, respectively; HR: 1.09; 95% CI: 0.68-1.74; P = 0.73). This trend persisted in both groups of multivessel (6.2% vs 5.7%; HR: 1.09; 95% CI: 0.62-1.89; P = 0.78) and left main disease (6.2% vs 5.7%; HR: 1.09; 95% CI: 0.46-2.56; P = 0.85) (P for interaction = 0.90). Routine surveillance functional testing was associated with increased rates of invasive angiography and repeat revascularization beyond 1 year.
In high-risk patients with multivessel or left main CAD who underwent PCI, there was no incremental clinical benefit from routine surveillance functional-testing compared with standard care alone during follow-up. (Pragmatic Trial Comparing Symptom-Oriented Versus Routine Stress Testing in High-Risk Patients Undergoing Percutaneous Coronary Intervention [POST-PCI]; NCT03217877).
对于多支血管病变或左主干冠状动脉疾病（CAD）的高危患者，经皮冠状动脉介入治疗（PCI）后的最佳监测策略仍不确定。
本研究旨在确定在接受 PCI 的多支血管病变或左主干 CAD 患者中常规功能检测的预后作用。
POST-PCI（比较高风险 PCI 患者症状导向与常规应激试验的实用试验）试验将高危 PCI 患者随机分为 1 年时常规功能检测组或仅在随访期间接受标准护理组。本分析重点关注多支血管病变或左主干 CAD 的患者。主要结局为 2 年时任何原因导致的死亡、心肌梗死或不稳定型心绞痛住院的复合终点。
在最初随机分组的 1706 名患者中，确定了 1192 名多支血管病变（n=833）或左主干病变（n=359）患者，其中 589 名患者在功能检测组，603 名患者在标准护理组。功能检测组和标准护理组的主要结局发生率在 2 年内相似（分别为 6.2%和 5.7%；HR：1.09；95%CI：0.68-1.74；P=0.73）。这种趋势在多支血管病变（6.2%和 5.7%；HR：1.09；95%CI：0.62-1.89；P=0.78）和左主干病变（6.2%和 5.7%；HR：1.09；95%CI：0.46-2.56；P=0.85）患者中均持续存在（P 组间交互作用=0.90）。常规监测功能检测与 1 年后侵入性血管造影和再次血运重建的发生率增加相关。
在接受 PCI 的多支血管病变或左主干 CAD 高危患者中，与单独标准护理相比，常规监测功能检测在随访期间没有带来额外的临床获益。（比较高风险 PCI 患者症状导向与常规应激试验的实用试验 [POST-PCI]；NCT03217877）
