Lack of benefit for routine functional testing early after coronary artery bypass graft surgery: results from the ROSETTA-CABG Registry.
BACKGROUND
There is little consensus regarding the use of functional testing after coronary artery bypass graft surgery (CABG). Some physicians opt for a routine functional testing strategy, while others employ a symptom-driven strategy.


OBJECTIVE
To examine the effects of routine post-CABG functional testing on the use of follow-up cardiac procedures and clinical events.


METHODS
The Routine versus Selective Exercise Treadmill Testing after Coronary Artery Bypass Graft Surgery (ROSETTA-CABG) Registry is a prospective, multicenter cohort study examining the use of functional testing after CABG among 408 patients. The frequencies of functional testing, cardiac procedures, and clinical events were examined during the first 12 months following a successful CABG.


RESULTS
Patients were predominantly male (80%) with a mean age of 63 +/- 10 years. During the 12-month follow up, 111 patients were observed to undergo a routine functional testing strategy, while 284 patients underwent a selective strategy. Patients undergoing routine functional testing underwent fewer follow-up cardiac catheterizations, but similar numbers of revascularization procedures (cardiac catheterizations = 0.9% vs. 8.1%; p = 0.027; percutaneous coronary intervention [PCI] = 0.9% vs. 4.6%; p = NS; repeat CABG = 0.0% vs. 0.0%; p = NS, respectively). However, clinical events were less common among patients who underwent routine functional testing including unstable angina (0.0% vs. 6.4%; p = NS), myocardial infarction (MI) (0.0% vs. 2.1%; p = NS), and death (0.9% vs. 1.4%; p = NS). The majority of clinical and procedural events occurred in the selective group who had a positive functional test (clinical events = 33%; procedural events = 40%). In contrast, no events occurred in patients in the routine group with a positive or indeterminate test, while those with a negative test had more events (6.3%) and procedures (6.3%).


CONCLUSIONS
Because routine functional testing 1 year after CABG is associated with extremely low event rates, this strategy does not appear to be warranted.
Jewish General Hospital/McGill University, Montréal, Québec, Canada.
Eisenberg
Mark J
MJ
Wou
Karen
K
Nguyen
Hiep
H
Duerr
Robert
R
Del Core
Michael
M
Fourchy
Dominique
D
Huynh
Thao
T
Lader
Ellis
E
Rogers
Felix J
FJ
Chaudhry
Rashid
R
Okrainec
Karen
K
Pilote
Louise
L
D000368:Aged; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D003331:Coronary Vessels / Q000503:physiopathology*; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D049268:Positron-Emission Tomography; D011184:Postoperative Period; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome