Routine functional testing versus selective functional testing among high-risk patients post-percutaneous coronary intervention: a systematic review and meta analysis
J Catangui, V T Sison, A J Guzman, N Pestano, F E PunzalanAbstract
Introduction
Routine functional testing after percutaneous coronary intervention (PCI) remains widely practiced in high-risk patients despite uncertainty in guideline recommendations. Its impact on clinical outcomes compared with a selective, symptom-driven approach is unclear.
Objectives
To evaluate whether routine functional testing reduces major adverse cardiovascular events (MACE) in high-risk post-PCI patients compared to selective functional testing and to assess its impact on rates of invasive angiography and repeat revascularization.
Methods
We systematically searched MEDLINE, HERDIN, and reference lists for randomized controlled trials (RCTs) comparing routine versus selective functional testing after PCI. Outcomes included all-cause mortality, cardiac death, myocardial infarction (MI), hospitalization for unstable angina (UA), invasive angiography, and repeat revascularization (PCI or CABG). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using fixed- and random-effects models.
Results
Three RCTs comprising 1,851 patients (925 routine; 926 selective) were included. Routine functional testing significantly increased repeat PCI (RR 1.48, 95% CI 1.03–2.11; p=0.03) without reducing all-cause mortality, cardiac death, MI, or hospitalization for UA. Rates of invasive angiography and CABG were similar between groups.
Conclusion
In high-risk post-PCI patients, routine functional testing increased repeat PCI without improving survival or reducing adverse cardiovascular outcomes. A selective, symptom-driven testing strategy may avoid unnecessary procedures, optimize care, and align follow-up care with patient-centered outcomes.Repeat PCIFor image description, please refer to the figure legend and surrounding text.Myocardial InfarctionFor image description, please refer to the figure legend and surrounding text.