Routine stress testing with subsequent coronary angiography versus standard of care in high-risk patients after percutaneous coronary intervention: An updated meta-analysis of randomized controlled trials

TL;DR

This study finds that routine stress testing after heart procedures in high-risk patients increases the need for further treatment but does not improve major health outcomes.

Contribution

An updated meta-analysis comparing routine stress testing with standard care in high-risk patients after PCI.

Findings

Routine stress testing increases the risk of target lesion revascularization.

No significant differences in all-cause mortality or heart attack rates between groups.

Routine stress testing does not reduce major adverse cardiovascular events.

Abstract

Routine stress testing with subsequent coronary angiography versus standard of care in high-risk patients after percutaneous coronary intervention: An updated meta-analysis of randomized controlled trials.

ACM, All-cause mortality; MACE, Major adverse cardiovascular events; MI, Myocardial infarction; PCI, Percutaneous coronary intervention; RCTs, Randomized controlled trials; TLR, Target lesion revascularisation.

•This study compared routine functional stress testing with standard care for high-risk patients after PCI.•Routine stress testing is associated with an increased risk of target lesion revascularization (TLR).•No significant differences were observed in all-cause mortality or myocardial infarction rates between the groups.•Routine stress testing did not reduce major adverse cardiovascular events (MACE).•These findings suggest that post-PCI coronary angiography should be reserved for patients with recurrent or new symptoms.

This study compared routine functional stress testing with standard care for high-risk patients after PCI.

Routine stress testing is associated with an increased risk of target lesion revascularization (TLR).

No significant differences were observed in all-cause mortality or myocardial infarction rates between the groups.

Routine stress testing did not reduce major adverse cardiovascular events (MACE).

These findings suggest that post-PCI coronary angiography should be reserved for patients with recurrent or new symptoms.

Routine functional stress testing with subsequent coronary angiography is undertaking to detect early restenosis and guide revascularization in high-risk patients after percutaneous coronary intervention (PCI). However, the safety and efficacy of routine functional stress testing over standard care is still debatable. This meta-analysis compares routine functional stress testing vs. standard care in high-risk patients after PCI. We systematically searched PubMed, Embase, and Cochrane Central databases to identify randomized controlled trials (RCTs) that compared functional stress testing versus standard of care after PCI in high-risk patients from inception to January 2025. We calculated the risk ratios (RRs) with 95 % confidence intervals (CIs) using the random-effects model for clinical outcomes. Four RCTs with 6,290 patients, of whom 3,206 (51 %) underwent routine functional stress testing were included in our analyses. The incidence of target lesion revascularization (TLR) was higher in routine functional stress testing (RR: 1.49; 95 % CI: 1.02–2.18; p = 0.038) compared with standard care. However, no statistically significant difference was observed for individual outcomes of all-cause mortality (RR: 0.89; 95 % CI: 0.48–1.18; p = 0.198), myocardial infarction (MI) (RR: 0.62; 95 % CI: 0.31–1.24; p = 0.174), and hospitalization for any cause (RR: 1.22; 95 % CI: 0.24–6.10; p = 0.809). The risk of MACE did not significantly differ between the groups (RR: 1.11; 95 % CI: 0.82–1.51; p = 0.480). Routine functional stress testing after PCI in high-risk patients was associated with increased incidence of target lesion revascularization, without reducing the risk of major adverse cardiovascular events.

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