Clinical impact of functional testing strategy among stented and non-stented patients: insights from the ROSETTA Registry.
The clinical utility of routine functional testing following percutaneous coronary intervention (PCI) among patients with and without coronary stenting is unclear. We established an international registry to evaluate the functional testing strategies following successful PCI. Among patients treated with stents, adverse cardiovascular outcomes were similar between those who underwent routine or clinically-driven functional testing. Conversely, among those who were not treated with stents, the rate of death, myocardial infarction or unstable angina was lower than those who underwent routine functional testing (14.8% vs. 6.6%; P=0.033). Our study suggests that routine functional testing may be beneficial to patients not treated with stents.


BACKGROUND
The role of routine functional testing following successful PCI is unclear. By improving patient outcomes with coronary stenting, the value of such a strategy may diminish.


OBJECTIVE
To determine the clinical utility of routine functional testing following PCI between patients with and without stenting.


METHODS
The routine versus selective exercise testing after angioplasty (ROSETTA) Registry was established to evaluate the utilization of functional testing following PCI. Use of functional testing, either routine or selective (clinically-driven), was left to the discretion of the attending physician.


RESULTS
Of 791 patients enrolled, 462 (58%) underwent coronary stenting. Stented patients were less likely to suffer from concomitant diseases but had more complex angiographic morphological characteristics. Between the groups of patients with and without stents, there was no difference in the proportion of patients undergoing routine functional testing (24% vs. 36%) or subsequent cardiac procedures (18.4% vs. 16.0%). Among patients with stents, outcomes at 6 months were similar between the groups undergoing routine and selective functional testing, including death (0% vs. 1.7%), myocardial infarction (0.9% vs. 2.0%), unstable angina (9.9% vs. 13.7%), repeat angiography (16.2% vs. 16.9%) and revascularization procedures (11.7% vs. 10.8%). However, among non-stented patients, selective functional testing was associated with a higher occurrence of death, myocardial infarction or unstable angina (14.8% vs. 6.6%; P=0.033). There was also no difference in the rates of repeat coronary angiography or revascularization procedures between these two strategies.


CONCLUSIONS
Although routine functional testing has little impact on outcomes among patients treated with coronary stents, non-stented patients may derive particular benefit.
Mak
Koon-Hou
KH
Department of Cardiology, National Heart Center, Mistri Wing, 17 Third Hospital Avenue, Singapore 168752, Singapore. mak_koon_hou@nhc.com.sg
Eisenberg
Mark J
MJ
Tsang
Janius
J
Okrainiec
K
K
Huynh
Thao
T
Brown
David L
DL
D015906:Angioplasty, Balloon, Coronary; D001208:Asia / Q000453:epidemiology; D001315:Australia / Q000453:epidemiology; D003327:Coronary Disease / Q000453:epidemiology / Q000401:mortality; D023903:Coronary Restenosis / Q000453:epidemiology / Q000517:prevention & control*; D005080:Exercise Test / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D015607:Stents