Routine functional testing after percutaneous coronary intervention: results of the Aggressive Diagnosis of Restenosis in High-Risk Patients (ADORE II) trial

Abstract

Background — It is unclear whether routine or selective functional testing is optimal following percutaneous coronary intervention (PCI) in high-risk patients.

Objectives — The aim of this trial was to compare exercise endurance, functional status, and quality of life (QOL) among high-risk patients randomized to either routine or selective functional testing following PCI.

Methods — We randomized 84patients to either routine or selective functional testing. Patients had one or more of the following: multivessel PCI, diabetes mellitus, left ventricular ejection fraction ≤ 35%, and/or PCI of the proximal left anterior descending artery. Patients in the routine arm (n=41) underwent maximum endurance exercise treadmill testing (ETT) with nuclear perfusion imaging at 1.5 and 6months. Patients in the selective arm (n=43) only underwent functional testing for a clinical indication.All patients underwent a maximum endurance ETT at 9months. Exercise endurance, functional status, and QOL were assessed at 9months.

Results — Most patients were middle-aged men (58±10years old; 87% male) who underwent PCI with stenting (94%).Among routine functional testing patients, 27.0% and 41.9% had a positive functional test at 1.5 and 6months, respectively. Exercise endurance was improved in the routine vs. selective arm at 9months (metabolic equivalents: 10.3±2.6 vs. 8.6±3.0, P=0.013).There was no difference in improvement from baseline for the Duke Activity Status Index, the Seattle Angina Questionnaire, or the SF-36. Nine-month cumulative incidences of cardiac procedures and clinical events were not significantly different.

Conclusions — Routine functional testing following PCI in high-risk patients may lead to improved exercise endurance but not improved QOL.

Key Words:

• PCI
• angioplasty
• restenosis
• functional testing
• stress testing
• high-risk patients