Six-month outcomes after single- and multi-lesion percutaneous coronary intervention: results from the ROSETTA registry.
BACKGROUND
The American College of Cardiology/American Heart Association exercise testing guidelines suggest that routine functional testing may benefit patients at high risk of restenosis, such as those undergoing multi-lesion percutaneous coronary intervention (PCI).


OBJECTIVE
To compare the six-month post-PCI clinical and procedural outcomes in patients following single- and multi-lesion PCI, and to examine the use of routine functional testing (ie, in all patients) versus selective functional testing (ie, only in those with recurrent symptoms) following multi-lesion PCI.


METHODS
Six-month outcomes among 562 patients after single-lesion PCI and 229 patients after multi-lesion PCI were examined. All patients were enrolled in the Routine versus Selective Exercise Treadmill Testing after Angioplasty (ROSETTA) registry, a prospective, multicentre registry examining the use of functional testing after successful PCI.


RESULTS
For single- versus multi-lesion PCI patients, respectively, rates of death (1.8% versus 2.2%, P=0.7) and myocardial infarction (0.7% versus 2.6%, P=0.03) were low in both groups. Rates of unstable angina (12.0% versus 11.7%, P=0.9) and the composite clinical end point of death, myocardial infarction or unstable angina (13.5% versus 13.9%, P=0.9) were similar. Multi-lesion PCI patients had a higher number of repeat PCI procedures (6.6% versus 13.4%, P=0.02) but there was no difference in the rates of coronary artery bypass graft surgery (3.0% versus 2.6%, P=0.7). A routine functional testing strategy was used in 28.0% of single-lesion and 31.6% of multi-lesion patients. In a multivariate analysis of the multi-lesion patients, routine functional testing was not associated with a significant reduction in the composite clinical event rate (odds ratio 0.5, 95% CI 0.2 to 1.7, P=0.27).


CONCLUSIONS
During the six-month period following successful PCI, clinical event rates were similar among patients undergoing single- or multi-lesion PCI. Routine functional testing was not associated with a statistically significant benefit in patients after multi-lesion PCI. However, additional study is required to better define the role of routine functional testing in this subgroup of patients.
Goldman
Lorne E
LE
Jewish General Hospital, Montreal, Quebec.
Okrainec
Karen
K
Eisenberg
Mark J
MJ
Schechter
David
D
Lefkovits
Jeffrey
J
Goudreau
Evelyne
E
Deligonul
Ubeydullah
U
Mak
Koon-Hou
KH
Del Core
Michael
M
Duerr
Robert
R
Huynh
Thao
T
Smilovitch
Mark
M
Sedlis
Steven
S
Brown
David L
DL
Brieger
David
D
D000789:Angina, Unstable / Q000453:epidemiology; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality; D003327:Coronary Disease / Q000473:pathology / Q000628:therapy; D023903:Coronary Restenosis / Q000175:diagnosis; D003331:Coronary Vessels / Q000473:pathology; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D012042:Registries; D016896:Treatment Outcome