Lack of benefit for routine functional testing early after coronary artery bypass graft surgery

Results from the ROSETTA-CABG registry

Mark J. Eisenberg, Karen Wou, Hiep Nguyen, Robert Duerr, Michael Del Core, Dominique Fourchy, Thao Huynh, Ellis Lader, Felix J. Rogers, Rashid Chaudhry, Karen Okrainec, Louise Pilote

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

BACKGROUND: There is little consensus regarding the use of functional testing after coronary artery bypass graft surgery (CABG). Some physicians opt for a routine functional testing strategy, while others employ a symptom-driven strategy. OBJECTIVE: To examine the effects of routine post-CABG functional testing on the use of follow-up cardiac procedures and clinical events. METHODS: The Routine versus Selective Exercise Treadmill Testing after Coronary Artery Bypass Graft Surgery (ROSETTA-CABG) Registry is a prospective, multicenter cohort study examining the use of functional testing after CABG among 408 patients. The frequencies of functional testing, cardiac procedures, and clinical events were examined during the first 12 months following a successful CABG. RESULTS: Patients were predominantly male (80%) with a mean age of 63 ± 10 years. During the 12-month follow up, 111 patients were observed to undergo a routine functional testing strategy, while 284 patients underwent a selective strategy. Patients undergoing routine functional testing underwent fewer follow-up cardiac catheterizations, but similar numbers of revascularization procedures (cardiac catheterizations ≤ 0.9% vs. 8.1%; p ≤ 0.027; percutaneous coronary intervention [PCI] ≤ 0.9% vs. 4.6%; p ≤ NS; repeat CABG ≤ 0.0% vs. 0.0%; p ≤ NS, respectively). However, clinical events were less common among patients who underwent routine functional testing including unstable angina (0.0% vs. 6.4%; p ≤ NS), myocardial infarction (MI) (0.0% vs. 2.1%; p ≤ NS), and death (0.9% vs. 1.4%; p ≤ NS). The majority of clinical and procedural events occurred in the selective group who had a positive functional test (clinical events ≤ 33%; procedural events ≤ 40%). In contrast, no events occurred in patients in the routine group with a positive or indeterminate test, while those with a negative test had more events (6.3%) and procedures (6.3%). CONCLUSIONS: Because routine functional testing 1 year after CABG is associated with extremely low event rates, this strategy does not appear to be warranted.

Original languageEnglish
Pages (from-to)147-152
Number of pages6
JournalJournal of Invasive Cardiology
Volume18
Issue number4
StatePublished - Apr 2006
Externally publishedYes

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Coronary Artery Bypass
Registries
Exercise
Transplants
Cardiac Catheterization
Unstable Angina
Percutaneous Coronary Intervention
Multicenter Studies
Cohort Studies
Myocardial Infarction
Physicians

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Lack of benefit for routine functional testing early after coronary artery bypass graft surgery : Results from the ROSETTA-CABG registry. / Eisenberg, Mark J.; Wou, Karen; Nguyen, Hiep; Duerr, Robert; Del Core, Michael; Fourchy, Dominique; Huynh, Thao; Lader, Ellis; Rogers, Felix J.; Chaudhry, Rashid; Okrainec, Karen; Pilote, Louise.

In: Journal of Invasive Cardiology, Vol. 18, No. 4, 04.2006, p. 147-152.

Research output: Contribution to journalArticle

Eisenberg, MJ, Wou, K, Nguyen, H, Duerr, R, Del Core, M, Fourchy, D, Huynh, T, Lader, E, Rogers, FJ, Chaudhry, R, Okrainec, K & Pilote, L 2006, 'Lack of benefit for routine functional testing early after coronary artery bypass graft surgery: Results from the ROSETTA-CABG registry', Journal of Invasive Cardiology, vol. 18, no. 4, pp. 147-152.
Eisenberg, Mark J. ; Wou, Karen ; Nguyen, Hiep ; Duerr, Robert ; Del Core, Michael ; Fourchy, Dominique ; Huynh, Thao ; Lader, Ellis ; Rogers, Felix J. ; Chaudhry, Rashid ; Okrainec, Karen ; Pilote, Louise. / Lack of benefit for routine functional testing early after coronary artery bypass graft surgery : Results from the ROSETTA-CABG registry. In: Journal of Invasive Cardiology. 2006 ; Vol. 18, No. 4. pp. 147-152.
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title = "Lack of benefit for routine functional testing early after coronary artery bypass graft surgery: Results from the ROSETTA-CABG registry",
abstract = "BACKGROUND: There is little consensus regarding the use of functional testing after coronary artery bypass graft surgery (CABG). Some physicians opt for a routine functional testing strategy, while others employ a symptom-driven strategy. OBJECTIVE: To examine the effects of routine post-CABG functional testing on the use of follow-up cardiac procedures and clinical events. METHODS: The Routine versus Selective Exercise Treadmill Testing after Coronary Artery Bypass Graft Surgery (ROSETTA-CABG) Registry is a prospective, multicenter cohort study examining the use of functional testing after CABG among 408 patients. The frequencies of functional testing, cardiac procedures, and clinical events were examined during the first 12 months following a successful CABG. RESULTS: Patients were predominantly male (80{\%}) with a mean age of 63 ± 10 years. During the 12-month follow up, 111 patients were observed to undergo a routine functional testing strategy, while 284 patients underwent a selective strategy. Patients undergoing routine functional testing underwent fewer follow-up cardiac catheterizations, but similar numbers of revascularization procedures (cardiac catheterizations ≤ 0.9{\%} vs. 8.1{\%}; p ≤ 0.027; percutaneous coronary intervention [PCI] ≤ 0.9{\%} vs. 4.6{\%}; p ≤ NS; repeat CABG ≤ 0.0{\%} vs. 0.0{\%}; p ≤ NS, respectively). However, clinical events were less common among patients who underwent routine functional testing including unstable angina (0.0{\%} vs. 6.4{\%}; p ≤ NS), myocardial infarction (MI) (0.0{\%} vs. 2.1{\%}; p ≤ NS), and death (0.9{\%} vs. 1.4{\%}; p ≤ NS). The majority of clinical and procedural events occurred in the selective group who had a positive functional test (clinical events ≤ 33{\%}; procedural events ≤ 40{\%}). In contrast, no events occurred in patients in the routine group with a positive or indeterminate test, while those with a negative test had more events (6.3{\%}) and procedures (6.3{\%}). CONCLUSIONS: Because routine functional testing 1 year after CABG is associated with extremely low event rates, this strategy does not appear to be warranted.",
author = "Eisenberg, {Mark J.} and Karen Wou and Hiep Nguyen and Robert Duerr and {Del Core}, Michael and Dominique Fourchy and Thao Huynh and Ellis Lader and Rogers, {Felix J.} and Rashid Chaudhry and Karen Okrainec and Louise Pilote",
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AU - Eisenberg, Mark J.

AU - Wou, Karen

AU - Nguyen, Hiep

AU - Duerr, Robert

AU - Del Core, Michael

AU - Fourchy, Dominique

AU - Huynh, Thao

AU - Lader, Ellis

AU - Rogers, Felix J.

AU - Chaudhry, Rashid

AU - Okrainec, Karen

AU - Pilote, Louise

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N2 - BACKGROUND: There is little consensus regarding the use of functional testing after coronary artery bypass graft surgery (CABG). Some physicians opt for a routine functional testing strategy, while others employ a symptom-driven strategy. OBJECTIVE: To examine the effects of routine post-CABG functional testing on the use of follow-up cardiac procedures and clinical events. METHODS: The Routine versus Selective Exercise Treadmill Testing after Coronary Artery Bypass Graft Surgery (ROSETTA-CABG) Registry is a prospective, multicenter cohort study examining the use of functional testing after CABG among 408 patients. The frequencies of functional testing, cardiac procedures, and clinical events were examined during the first 12 months following a successful CABG. RESULTS: Patients were predominantly male (80%) with a mean age of 63 ± 10 years. During the 12-month follow up, 111 patients were observed to undergo a routine functional testing strategy, while 284 patients underwent a selective strategy. Patients undergoing routine functional testing underwent fewer follow-up cardiac catheterizations, but similar numbers of revascularization procedures (cardiac catheterizations ≤ 0.9% vs. 8.1%; p ≤ 0.027; percutaneous coronary intervention [PCI] ≤ 0.9% vs. 4.6%; p ≤ NS; repeat CABG ≤ 0.0% vs. 0.0%; p ≤ NS, respectively). However, clinical events were less common among patients who underwent routine functional testing including unstable angina (0.0% vs. 6.4%; p ≤ NS), myocardial infarction (MI) (0.0% vs. 2.1%; p ≤ NS), and death (0.9% vs. 1.4%; p ≤ NS). The majority of clinical and procedural events occurred in the selective group who had a positive functional test (clinical events ≤ 33%; procedural events ≤ 40%). In contrast, no events occurred in patients in the routine group with a positive or indeterminate test, while those with a negative test had more events (6.3%) and procedures (6.3%). CONCLUSIONS: Because routine functional testing 1 year after CABG is associated with extremely low event rates, this strategy does not appear to be warranted.

AB - BACKGROUND: There is little consensus regarding the use of functional testing after coronary artery bypass graft surgery (CABG). Some physicians opt for a routine functional testing strategy, while others employ a symptom-driven strategy. OBJECTIVE: To examine the effects of routine post-CABG functional testing on the use of follow-up cardiac procedures and clinical events. METHODS: The Routine versus Selective Exercise Treadmill Testing after Coronary Artery Bypass Graft Surgery (ROSETTA-CABG) Registry is a prospective, multicenter cohort study examining the use of functional testing after CABG among 408 patients. The frequencies of functional testing, cardiac procedures, and clinical events were examined during the first 12 months following a successful CABG. RESULTS: Patients were predominantly male (80%) with a mean age of 63 ± 10 years. During the 12-month follow up, 111 patients were observed to undergo a routine functional testing strategy, while 284 patients underwent a selective strategy. Patients undergoing routine functional testing underwent fewer follow-up cardiac catheterizations, but similar numbers of revascularization procedures (cardiac catheterizations ≤ 0.9% vs. 8.1%; p ≤ 0.027; percutaneous coronary intervention [PCI] ≤ 0.9% vs. 4.6%; p ≤ NS; repeat CABG ≤ 0.0% vs. 0.0%; p ≤ NS, respectively). However, clinical events were less common among patients who underwent routine functional testing including unstable angina (0.0% vs. 6.4%; p ≤ NS), myocardial infarction (MI) (0.0% vs. 2.1%; p ≤ NS), and death (0.9% vs. 1.4%; p ≤ NS). The majority of clinical and procedural events occurred in the selective group who had a positive functional test (clinical events ≤ 33%; procedural events ≤ 40%). In contrast, no events occurred in patients in the routine group with a positive or indeterminate test, while those with a negative test had more events (6.3%) and procedures (6.3%). CONCLUSIONS: Because routine functional testing 1 year after CABG is associated with extremely low event rates, this strategy does not appear to be warranted.

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