Utility of routine functional testing after percutaneous transluminal coronary angioplasty. Results from the ROSETTA registry

Mark J. Eisenberg, David Schechter, Jeffrey Lefkovits, Evelyne Goudreau, Ubeydullah Deligonul, Koon Hou Mak, Robert Duerr, Michael Del Core, Philippe Garzon, Thao Huynh, Mark Smilovitch, Steven Sedlis, David L. Brown, David Brieger, Louise Pilote

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background. There is little consensus regarding the use of functional testing after percutaneous transluminal coronary angioplasty (PTCA). Some physicians employ a routine functional testing strategy, and others employ a symptom-driven strategy. Objective. To examine the effects of routine post-PTCA functional testing on the use of follow-up cardiac procedures and clinical events. Methods. The Routine versus Selective Exercise Treadmill Testing after Angioplasty (ROSETTA) Registry is a prospective multicenter observational study examining the use of functional testing after PTCA. A total of 788 patients (pts) were enrolled in the ROSETTA Registry at 13 clinical centers in 5 countries. The frequencies of functional testing, cardiac procedures and clinical events were examined during the first 6 months following a successful PTCA. Results. Patients were predominantly elderly men (mean age, 61 ± 11 years; 76% male) who underwent single-vessel PTCA (85%) with stent implantation (58%). During the 6-month follow-up, a total of 237 pts were observed to undergo a routine functional testing strategy (100% having functional testing for routine follow-up), while 551 pts underwent a selective (or clinically-driven) strategy (73% having no functional testing and 27% having functional testing for a clinical indication). Patients in the routine testing group underwent a total of 344 functional tests compared with 165 tests performed in the selective testing group (mean, 1.45 tests/patient versus 0.3 tests/patient; p <0.0001). There was little difference in the rates of follow-up cardiac procedures among the pts undergoing the routine and selective testing strategies [cardiac catheterization, 13.9% versus 17.5% (p = NS); percutaneous coronary intervention (PCI), 8.4% versus 8.7% (p = NS); coronary artery bypass graft surgery, 2.1% versus 3.3% (p = NS)]. However, clinical events were less common among pts who underwent routine functional testing, e.g., unstable angina (6.1% versus 14.4%; p = 0.001), myocardial infarction (0.4% versus 1.6%; p = NS), death (0% versus 2.2%; p = 0.02) and composite clinical events (6.3% versus 16.3%; p <0.0001). After controlling for baseline clinical and procedural differences, routine functional testing had a persistent independent association with a reduction in the composite clinical event rate (odds ratio, 0.45; 95% confidence interval, 0.24-0.81; p = 0.008). Conclusion. Routine functional testing after PTCA is associated with a reduction in the frequency of follow-up clinical events. This association may be attributable to the early identification and treatment of pts at risk for follow-up events, or it may be due to clinical differences between pts who are referred for routine and selective functional testing.

Original languageEnglish
Pages (from-to)318-322
Number of pages5
JournalJournal of Invasive Cardiology
Volume16
Issue number6
StatePublished - Jun 2004
Externally publishedYes

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Coronary Balloon Angioplasty
Angioplasty
Registries
Exercise
Unstable Angina
Percutaneous Coronary Intervention
Cardiac Catheterization
Coronary Artery Bypass
Multicenter Studies
Stents
Observational Studies
Odds Ratio
Myocardial Infarction
Confidence Intervals
Physicians
Transplants

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Eisenberg, M. J., Schechter, D., Lefkovits, J., Goudreau, E., Deligonul, U., Mak, K. H., ... Pilote, L. (2004). Utility of routine functional testing after percutaneous transluminal coronary angioplasty. Results from the ROSETTA registry. Journal of Invasive Cardiology, 16(6), 318-322.

Utility of routine functional testing after percutaneous transluminal coronary angioplasty. Results from the ROSETTA registry. / Eisenberg, Mark J.; Schechter, David; Lefkovits, Jeffrey; Goudreau, Evelyne; Deligonul, Ubeydullah; Mak, Koon Hou; Duerr, Robert; Del Core, Michael; Garzon, Philippe; Huynh, Thao; Smilovitch, Mark; Sedlis, Steven; Brown, David L.; Brieger, David; Pilote, Louise.

In: Journal of Invasive Cardiology, Vol. 16, No. 6, 06.2004, p. 318-322.

Research output: Contribution to journalArticle

Eisenberg, MJ, Schechter, D, Lefkovits, J, Goudreau, E, Deligonul, U, Mak, KH, Duerr, R, Del Core, M, Garzon, P, Huynh, T, Smilovitch, M, Sedlis, S, Brown, DL, Brieger, D & Pilote, L 2004, 'Utility of routine functional testing after percutaneous transluminal coronary angioplasty. Results from the ROSETTA registry', Journal of Invasive Cardiology, vol. 16, no. 6, pp. 318-322.
Eisenberg MJ, Schechter D, Lefkovits J, Goudreau E, Deligonul U, Mak KH et al. Utility of routine functional testing after percutaneous transluminal coronary angioplasty. Results from the ROSETTA registry. Journal of Invasive Cardiology. 2004 Jun;16(6):318-322.
Eisenberg, Mark J. ; Schechter, David ; Lefkovits, Jeffrey ; Goudreau, Evelyne ; Deligonul, Ubeydullah ; Mak, Koon Hou ; Duerr, Robert ; Del Core, Michael ; Garzon, Philippe ; Huynh, Thao ; Smilovitch, Mark ; Sedlis, Steven ; Brown, David L. ; Brieger, David ; Pilote, Louise. / Utility of routine functional testing after percutaneous transluminal coronary angioplasty. Results from the ROSETTA registry. In: Journal of Invasive Cardiology. 2004 ; Vol. 16, No. 6. pp. 318-322.
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title = "Utility of routine functional testing after percutaneous transluminal coronary angioplasty. Results from the ROSETTA registry",
abstract = "Background. There is little consensus regarding the use of functional testing after percutaneous transluminal coronary angioplasty (PTCA). Some physicians employ a routine functional testing strategy, and others employ a symptom-driven strategy. Objective. To examine the effects of routine post-PTCA functional testing on the use of follow-up cardiac procedures and clinical events. Methods. The Routine versus Selective Exercise Treadmill Testing after Angioplasty (ROSETTA) Registry is a prospective multicenter observational study examining the use of functional testing after PTCA. A total of 788 patients (pts) were enrolled in the ROSETTA Registry at 13 clinical centers in 5 countries. The frequencies of functional testing, cardiac procedures and clinical events were examined during the first 6 months following a successful PTCA. Results. Patients were predominantly elderly men (mean age, 61 ± 11 years; 76{\%} male) who underwent single-vessel PTCA (85{\%}) with stent implantation (58{\%}). During the 6-month follow-up, a total of 237 pts were observed to undergo a routine functional testing strategy (100{\%} having functional testing for routine follow-up), while 551 pts underwent a selective (or clinically-driven) strategy (73{\%} having no functional testing and 27{\%} having functional testing for a clinical indication). Patients in the routine testing group underwent a total of 344 functional tests compared with 165 tests performed in the selective testing group (mean, 1.45 tests/patient versus 0.3 tests/patient; p <0.0001). There was little difference in the rates of follow-up cardiac procedures among the pts undergoing the routine and selective testing strategies [cardiac catheterization, 13.9{\%} versus 17.5{\%} (p = NS); percutaneous coronary intervention (PCI), 8.4{\%} versus 8.7{\%} (p = NS); coronary artery bypass graft surgery, 2.1{\%} versus 3.3{\%} (p = NS)]. However, clinical events were less common among pts who underwent routine functional testing, e.g., unstable angina (6.1{\%} versus 14.4{\%}; p = 0.001), myocardial infarction (0.4{\%} versus 1.6{\%}; p = NS), death (0{\%} versus 2.2{\%}; p = 0.02) and composite clinical events (6.3{\%} versus 16.3{\%}; p <0.0001). After controlling for baseline clinical and procedural differences, routine functional testing had a persistent independent association with a reduction in the composite clinical event rate (odds ratio, 0.45; 95{\%} confidence interval, 0.24-0.81; p = 0.008). Conclusion. Routine functional testing after PTCA is associated with a reduction in the frequency of follow-up clinical events. This association may be attributable to the early identification and treatment of pts at risk for follow-up events, or it may be due to clinical differences between pts who are referred for routine and selective functional testing.",
author = "Eisenberg, {Mark J.} and David Schechter and Jeffrey Lefkovits and Evelyne Goudreau and Ubeydullah Deligonul and Mak, {Koon Hou} and Robert Duerr and {Del Core}, Michael and Philippe Garzon and Thao Huynh and Mark Smilovitch and Steven Sedlis and Brown, {David L.} and David Brieger and Louise Pilote",
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TY - JOUR

T1 - Utility of routine functional testing after percutaneous transluminal coronary angioplasty. Results from the ROSETTA registry

AU - Eisenberg, Mark J.

AU - Schechter, David

AU - Lefkovits, Jeffrey

AU - Goudreau, Evelyne

AU - Deligonul, Ubeydullah

AU - Mak, Koon Hou

AU - Duerr, Robert

AU - Del Core, Michael

AU - Garzon, Philippe

AU - Huynh, Thao

AU - Smilovitch, Mark

AU - Sedlis, Steven

AU - Brown, David L.

AU - Brieger, David

AU - Pilote, Louise

PY - 2004/6

Y1 - 2004/6

N2 - Background. There is little consensus regarding the use of functional testing after percutaneous transluminal coronary angioplasty (PTCA). Some physicians employ a routine functional testing strategy, and others employ a symptom-driven strategy. Objective. To examine the effects of routine post-PTCA functional testing on the use of follow-up cardiac procedures and clinical events. Methods. The Routine versus Selective Exercise Treadmill Testing after Angioplasty (ROSETTA) Registry is a prospective multicenter observational study examining the use of functional testing after PTCA. A total of 788 patients (pts) were enrolled in the ROSETTA Registry at 13 clinical centers in 5 countries. The frequencies of functional testing, cardiac procedures and clinical events were examined during the first 6 months following a successful PTCA. Results. Patients were predominantly elderly men (mean age, 61 ± 11 years; 76% male) who underwent single-vessel PTCA (85%) with stent implantation (58%). During the 6-month follow-up, a total of 237 pts were observed to undergo a routine functional testing strategy (100% having functional testing for routine follow-up), while 551 pts underwent a selective (or clinically-driven) strategy (73% having no functional testing and 27% having functional testing for a clinical indication). Patients in the routine testing group underwent a total of 344 functional tests compared with 165 tests performed in the selective testing group (mean, 1.45 tests/patient versus 0.3 tests/patient; p <0.0001). There was little difference in the rates of follow-up cardiac procedures among the pts undergoing the routine and selective testing strategies [cardiac catheterization, 13.9% versus 17.5% (p = NS); percutaneous coronary intervention (PCI), 8.4% versus 8.7% (p = NS); coronary artery bypass graft surgery, 2.1% versus 3.3% (p = NS)]. However, clinical events were less common among pts who underwent routine functional testing, e.g., unstable angina (6.1% versus 14.4%; p = 0.001), myocardial infarction (0.4% versus 1.6%; p = NS), death (0% versus 2.2%; p = 0.02) and composite clinical events (6.3% versus 16.3%; p <0.0001). After controlling for baseline clinical and procedural differences, routine functional testing had a persistent independent association with a reduction in the composite clinical event rate (odds ratio, 0.45; 95% confidence interval, 0.24-0.81; p = 0.008). Conclusion. Routine functional testing after PTCA is associated with a reduction in the frequency of follow-up clinical events. This association may be attributable to the early identification and treatment of pts at risk for follow-up events, or it may be due to clinical differences between pts who are referred for routine and selective functional testing.

AB - Background. There is little consensus regarding the use of functional testing after percutaneous transluminal coronary angioplasty (PTCA). Some physicians employ a routine functional testing strategy, and others employ a symptom-driven strategy. Objective. To examine the effects of routine post-PTCA functional testing on the use of follow-up cardiac procedures and clinical events. Methods. The Routine versus Selective Exercise Treadmill Testing after Angioplasty (ROSETTA) Registry is a prospective multicenter observational study examining the use of functional testing after PTCA. A total of 788 patients (pts) were enrolled in the ROSETTA Registry at 13 clinical centers in 5 countries. The frequencies of functional testing, cardiac procedures and clinical events were examined during the first 6 months following a successful PTCA. Results. Patients were predominantly elderly men (mean age, 61 ± 11 years; 76% male) who underwent single-vessel PTCA (85%) with stent implantation (58%). During the 6-month follow-up, a total of 237 pts were observed to undergo a routine functional testing strategy (100% having functional testing for routine follow-up), while 551 pts underwent a selective (or clinically-driven) strategy (73% having no functional testing and 27% having functional testing for a clinical indication). Patients in the routine testing group underwent a total of 344 functional tests compared with 165 tests performed in the selective testing group (mean, 1.45 tests/patient versus 0.3 tests/patient; p <0.0001). There was little difference in the rates of follow-up cardiac procedures among the pts undergoing the routine and selective testing strategies [cardiac catheterization, 13.9% versus 17.5% (p = NS); percutaneous coronary intervention (PCI), 8.4% versus 8.7% (p = NS); coronary artery bypass graft surgery, 2.1% versus 3.3% (p = NS)]. However, clinical events were less common among pts who underwent routine functional testing, e.g., unstable angina (6.1% versus 14.4%; p = 0.001), myocardial infarction (0.4% versus 1.6%; p = NS), death (0% versus 2.2%; p = 0.02) and composite clinical events (6.3% versus 16.3%; p <0.0001). After controlling for baseline clinical and procedural differences, routine functional testing had a persistent independent association with a reduction in the composite clinical event rate (odds ratio, 0.45; 95% confidence interval, 0.24-0.81; p = 0.008). Conclusion. Routine functional testing after PTCA is associated with a reduction in the frequency of follow-up clinical events. This association may be attributable to the early identification and treatment of pts at risk for follow-up events, or it may be due to clinical differences between pts who are referred for routine and selective functional testing.

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