Routine stress tests after PCI make little difference, even in high-risk ACS patients (2024)

Stress testing high-risk patients 12 months after percutaneous coronary intervention (PCI) does not provide significant value. But what if the patient presents with acute coronary syndrome (ACS), which is known to be associated with certain cardiovascular risks?

A team of researchers investigated that very question, sharing their findings in JAMA Cardiology.[1]

“The appropriate follow-up surveillance strategy for patients with ACS who have undergone PCI remains debated, and theoretical arguments have been made to support an active surveillance follow-up strategy to reduce the risk of future ischemic events,” wrote first author Jinho Lee, MD, a cardiologist with the University of Ulsan College of Medicine in South Korea, and colleagues. “In real-world clinical practice, routine surveillance stress testing has commonly been implemented as part of post-PCI management, but its prognostic value is still uncertain in high-risk patients presenting with ACS who have undergone PCI.”

Lee, et al. performed a secondary analysis of data from the POST-PCI randomized clinical trial, which examined different follow-up strategies in more than 1,500 high-risk PCI patients. Initial POST-PCI findings were published in The New England Journal of Medicine in August 2022.[2] A separate secondary analysis was published in the Journal of the American College of Cardiology in March 2024.[3]

POST-PCI included 1,709 high-risk PCI patients treated at one of 11 hospitals in South Korea from November 2017 to September 2019. The mean patient age was 64.7 years old, and more than 99% were Asian. Overall, 30.6% of patients presented with ACS. While 62.9% of those patients had a history of STEMI or non-STEMI, the other 37.1% presented with unstable angina.

All patients—including those with and without an ACS diagnosis—were randomized to be treated with a functional testing strategy or standard care. The stress testing group underwent “routine cardiac stress testing, including exercise electrocardiography, nuclear stress testing or stress echocardiography, at 12 months after randomization.” The standard care group did not.

The study’s primary composite outcome—all-cause mortality, myocardial infarction or hospitalization for unstable angina after two years—was seen in 6.6% of ACS patients from the stress testing group and 8.5% of ACS patients from the standard care group. That same outcome was seen in 5.1% of patients without ACS from the stress testing group and 4.9% of patients without ACS from the standard care group.

“The pattern of nonsignificant difference was similar for each individual component of the primary outcome and other key secondary outcomes according to the presence or absence of ACS and the randomized follow-up strategy,” the authors wrote.

The authors did emphasize that, “regardless of ACS status, the maintenance of and compliance with optical medical therapy, including antiplatelet and statin therapy, during follow-up may have a positive effect on improving outcomes.”

Click here to read the full study in JAMA Cardiology.