Pragmatic trial comparing routine versus no routine functional testing in high-risk patients who underwent percutaneous coronary intervention: Rationale and design of POST-PCI trial

Although the need to detect restenosis has diminished in the contemporary practice of percutaneous coronary intervention (PCI) with drug-eluting stents (DES), the surveillance of ischemia owing to restenosis or disease progression deserves attention in high-risk PCI settings. It is unknown whether f...

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Bibliographic Details
Published in:The American heart journal 2020-06, Vol.224, p.156-165
Main Authors: Yoon, Yong-Hoon, Ahn, Jung-Min, Kang, Do-Yoon, Park, Hanbit, Cho, Sang-Cheol, Lee, Pil Hyung, Hur, Seung-Ho, Kim, Won-Jang, Park, Chul Soo, Lee, Bong-Ki, Suh, Jung-Won, Yoon, Jung Han, Choi, Jae Woong, Kim, Ki-Sik, Choi, Si Wan, Lee, Su Nam, Park, Seung-Jung, Park, Duk-Woo
Format: Article
Language:English
Subjects:
Angina
Angina pectoris
Angioplasty
Cardiovascular disease
Cardiovascular diseases
Clinical medicine
Diagnostic systems
Drug delivery
Echocardiography
EKG
Electrocardiography
Functional testing
Health risks
Health surveillance
Implants
Ischemia
Myocardial infarction
Patients
Physicians
Population
Restenosis
Risk
Risk groups
Stress
Testing laboratories
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Summary:Although the need to detect restenosis has diminished in the contemporary practice of percutaneous coronary intervention (PCI) with drug-eluting stents (DES), the surveillance of ischemia owing to restenosis or disease progression deserves attention in high-risk PCI settings. It is unknown whether follow-up strategy of routine noninvasive functional testing potentially reduces the risk of major cardiovascular events in high-risk PCI patients. The POST-PCI study is an investigator-initiated, multicenter, prospective randomized trial comparing the effectiveness of two follow-up strategies in patients with high-risk anatomic or clinical characteristics who underwent PCI. Study participants were randomly assigned to either (1) the routine noninvasive stress testing (exercise electrocardiography, nuclear stress imaging, or stress echocardiography) at 12 months post-PCI or (2) the standard-care without routine testing. In the routine stress testing group, depending on the testing results, all clinical decisions regarding subsequent diagnostic or therapeutic procedures were at the treating physician's discretion. The primary endpoint was a composite outcome of death from any causes, myocardial infarction, or hospitalization for unstable angina at 2 years post-PCI. More than 1700 high-risk PCI patients have been randomized over 2.0 years at 11 major cardiac centers in Korea. This pragmatic POST-PCI trial will provide valuable clinical evidence on the effectiveness of follow-up strategy of routine noninvasive stress testing in high-risk PCI patients.
ISSN:0002-8703
1097-6744
DOI:10.1016/j.ahj.2020.03.019