title: Utility of routine functional testing after percutaneous transluminal coronary angioplasty: results from the ROSETTA registry.
abstract: BACKGROUND
  There is little consensus regarding the use of functional testing after percutaneous transluminal coronary angioplasty (PTCA). Some physicians employ a routine functional testing strategy, and others employ a symptom-driven strategy.
  
  
  OBJECTIVE
  To examine the effects of routine post-PTCA functional testing on the use of follow-up cardiac procedures and clinical events.
  
  
  METHODS
  The Routine versus Selective Exercise Treadmill Testing after Angioplasty (ROSETTA) Registry is a prospective multicenter observational study examining the use of functional testing after PTCA. A total of 788 patients (pts) were enrolled in the ROSETTA Registry at 13 clinical centers in 5 countries. The frequencies of functional testing, cardiac procedures and clinical events were examined during the first 6 months following a successful PTCA.
  
  
  RESULTS
  Patients were predominantly elderly men (mean age, 61+/-11 years; 76% male) who underwent single-vessel PTCA (85%) with stent implantation (58%). During the 6-month follow-up, a total of 237 pts were observed to undergo a routine functional testing strategy (100% having functional testing for routine follow-up), while 551 pts underwent a selective (or clinically-driven) strategy (73% having no functional testing and 27% having functional testing for a clinical indication). Patients in the routine testing group underwent a total of 344 functional tests compared with 165 tests performed in the selective testing group (mean, 1.45 tests/patient versus 0.3 tests/patient; p<0.0001). There was little difference in the rates of follow-up cardiac procedures among the pts undergoing the routine and selective testing strategies [cardiac catheterization, 13.9% versus 17.5% (p=NS); percutaneous coronary intervention (PCI), 8.4% versus 8.7% (p=NS); coronary artery bypass graft surgery, 2.1% versus 3.3% (p=NS)]. However, clinical events were less common among pts who underwent routine functional testing, e.g., unstable angina (6.1% versus 14.4%; p=0.001), myocardial infarction (0.4% versus 1.6%; p=NS), death (0% versus 2.2%; p=0.02) and composite clinical events (6.3% versus 16.3%; p<0.0001). After controlling for baseline clinical and procedural differences, routine functional testing had a persistent independent association with a reduction in the composite clinical event rate (odds ratio, 0.45; 95% confidence interval, 0.24-0.81; p=0.008).
  
  
  CONCLUSIONS
  Routine functional testing after PTCA is associated with a reduction in the frequency of follow-up clinical events. This association may be attributable to the early identification and treatment of pts at risk for follow-up events, or it may be due to clinical differences between pts who are referred for routine and selective functional testing.
authors.affiliation: Division of Cardiology, Jewish General Hospital/McGill University, Montreal, Quebec, Canada. marke@epid.jgh.mcgill.ca
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Eisenberg
authors.forename: David
authors.initials: D
authors.lastname: Schechter
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lefkovits
authors.forename: Evelyne
authors.initials: E
authors.lastname: Goudreau
authors.forename: Ubeydullah
authors.initials: U
authors.lastname: Deligonul
authors.forename: Koon-Hou
authors.initials: KH
authors.lastname: Mak
authors.forename: Robert
authors.initials: R
authors.lastname: Duerr
authors.forename: Michael
authors.initials: M
authors.lastname: Del Core
authors.forename: Philippe
authors.initials: P
authors.lastname: Garzon
authors.forename: Thao
authors.initials: T
authors.lastname: Huynh
authors.forename: Mark
authors.initials: M
authors.lastname: Smilovitch
authors.forename: Steven
authors.initials: S
authors.lastname: Sedlis
authors.forename: David L
authors.initials: DL
authors.lastname: Brown
authors.forename: David
authors.initials: D
authors.lastname: Brieger
authors.forename: Louise
authors.initials: L
authors.lastname: Pilote
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D005080:Exercise Test; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012042:Registries