{
  "abstract": "Objective The optimal follow-up strategy for high-risk patients who underwent imaging-guided or physiology-guided percutaneous coronary intervention (PCI) remains uncertain. We investigated whether routine surveillance stress testing after PCI provides clinical benefit when the procedure is guided by intravascular ultrasonography (IVUS) or fractional flow reserve (FFR).Methods In the Pragmatic Trial Comparing Symptom-Oriented vs Routine Stress Testing in High-Risk Patients Undergoing PCI randomised trial, 1706 high-risk patients who underwent PCI were assigned to either routine functional testing at 1 year or standard care alone. In this prespecified subgroup analysis, patients were subsequently categorised according to whether IVUS or FFR was used at the index procedure. The primary outcome was a composite of death, myocardial infarction or hospitalisation for unstable angina over 2 years.Results Among the randomised population, 74% underwent IVUS-guided intervention and 36% underwent FFR-guided intervention. At 2 years, rates of the primary outcome were similar between routine testing and standard care both in patients treated with IVUS guidance (5.3% vs 6.7%; HR 0.79; 95% CI 0.50 to 1.24) and without IVUS guidance (5.7% vs 3.8%; HR 1.52; 95% CI 0.63 to 3.68; interaction p=0.21). Comparable results were observed in patients with FFR guidance (2.6% vs 3.9%; HR 0.65; 95% CI 0.26 to 1.58) and without FFR guidance (7.0% vs 7.1%; HR 0.99; 95% CI 0.63 to 1.55; interaction p=0.59). Routine functional testing was consistently associated with higher use of invasive coronary angiography and repeat revascularisation, without improvement in clinical outcomes.Conclusions Among high-risk patients who underwent PCI, routine surveillance stress testing did not reduce the risk of death, myocardial infarction or unstable angina, regardless of the use of IVUS or FFR at the index procedure. Routine functional testing increased downstream invasive procedures without clinical benefit. These findings support guideline recommendations against routine surveillance testing after PCI.Trial registration number NCT03217877.",
  "authors": [
    {
      "affiliations": [
        "Division of Cardiology, Hanmaeum Changwon Hospital, Hanyang University Medical Center, Changwon, Korea",
        "Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea"
      ],
      "name": "Yeonwoo Choi"
    },
    {
      "affiliations": [
        "Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea"
      ],
      "name": "Do-Yoon Kang"
    },
    {
      "affiliations": [
        "Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea"
      ],
      "name": "Hoyun Kim"
    },
    {
      "affiliations": [
        "Division of Cardiology, KyungHee Medical Center, KyungHee University, Seoul, Korea"
      ],
      "name": "Jinho Lee"
    },
    {
      "affiliations": [
        "Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea"
      ],
      "name": "Sangyong Jo"
    },
    {
      "affiliations": [
        "Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea"
      ],
      "name": "Jung-Min Ahn"
    },
    {
      "affiliations": [
        "Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea"
      ],
      "name": "Nayoung Kim"
    },
    {
      "affiliations": [
        "Division of Cardiology, Chungnam National University Sejong Hospital, Sejong, Korea"
      ],
      "name": "Yong-Hoon Yoon"
    },
    {
      "affiliations": [
        "Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea"
      ],
      "name": "Seung-Ho Hur"
    },
    {
      "affiliations": [
        "Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea"
      ],
      "name": "Cheol Hyun Lee"
    },
    {
      "affiliations": [
        "Division of Cardiology, CHA Bundang Medical Center, Seongnam, Korea"
      ],
      "name": "Won-Jang Kim"
    },
    {
      "affiliations": [
        "Division of Cardiology, CHA Bundang Medical Center, Seongnam, Korea"
      ],
      "name": "Se Hun Kang"
    },
    {
      "affiliations": [
        "Cardiovascular Center and Cardiology Division, Yeouido St. Mary’s Hospital, Seoul, Korea"
      ],
      "name": "Chul-Su Park"
    },
    {
      "affiliations": [
        "Division of Cardiology, Kangwon National University Hospital, Chuncheon, Korea"
      ],
      "name": "Bong-Ki Lee"
    },
    {
      "affiliations": [
        "Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea"
      ],
      "name": "Jung-Won Suh"
    },
    {
      "affiliations": [
        "Division of Cardiology, Eulji General Hospital, Seoul, Korea"
      ],
      "name": "Jae Woong Choi"
    },
    {
      "affiliations": [
        "Division of Cardiology, Daegu Catholic University Medical Center, Deagu, Korea"
      ],
      "name": "Kee-Sik Kim"
    },
    {
      "affiliations": [
        "Division of Cardiology, St. Vincent’s Hospital, Suwon, Korea"
      ],
      "name": "Su Nam Lee"
    },
    {
      "affiliations": [
        "Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea"
      ],
      "name": "Seung-Jung Park"
    },
    {
      "affiliations": [
        "Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea"
      ],
      "name": "Duk-Woo Park"
    },
    {
      "affiliations": [],
      "name": "for the POST-PCI Investigators"
    }
  ],
  "title": "Role of routine surveillance stress testing in patients with or without imaging-guided or physiology-guided PCI",
  "uid": "19515a15-d183-5fc9-9826-d65a1d917144"
}