The use of functional tests and planned coronary angiography after percutaneous coronary revascularization in clinical practice.Results from the AFTER multicenter study

Follow‐up strategies and individual risk profile after percutaneous coronary intervention: The prospective post percutaneous coronary intervention registry

“…In our population, 35% of the patients underwent at least one noninvasive stress test within 12 months, a value that is lower compared to 61 and 66%, respectively, reported by two previous registries 13,14 . Shah et al 2 reported a rate of 61% of stress test in the first year after PCI in privately insured patients <65 years old, a rate that was similar to the data of Mudrick et al 16 Despite we cannot exclude that the difference, particularly with the results of Shah et al, depends on the younger age of the patients and on the different reimbursement strategies, 2 the reason of the discrepancy with other registries 13,14 is less evident and it might be explained by the physicians who actually performed the follow‐up and by the different period of data collection.…”

“…In ACS patients with older age, with more comorbidities (i.e., renal failure), with more previous cardiovascular events, with complex coronary anatomy are more likely to receive clopidogrel and not ticagrelor or prasugrel, and are less likely to undergo an invasive strategy and to be treated with a drug eluting stent (DES) compared to a bare metal stent 10 . Despite data investigating the choice, the type, and the impact on prognosis are lacking and obtained by observational studies, stress tests after PCI are often redundant and performed in low risk patients, leading to an increase rate of hospitalization and coronary angiography, not followed by revascularization 11,12 ; in ROSETTA and in AFTER registry, most stress tests following PCI were routinely performed (with a wide variation among centers) and not driven by a clinical requirement; younger age, sex, and logistic were the only independent predictors of their use 13,14 …”

“…The follow‐up of most patients (81%) was performed by the cardiology department involved in the hospital care of the index PCI; conversely, in the AFTER registry this rate was nearly 40%, but this “follow‐up location” doubled the probability to undergo a stress test 14 . Furthermore, the present registry is more recent compared with the aforementioned studies, 2,13‐16 and it was performed 3 years after the 2014 ESC Guidelines on myocardial revascularization that recommend routine stress test >2 years after PCI and >5 years after CABG in asymptomatic patients 8…”

A multidisciplinary consensus document on follow‐up strategies for patients treated with percutaneous coronary intervention

“…Of note, freedom from angina can greatly vary from 66% in the PCI group of COURAGE to 81% in the PCI group of FAME , a difference which may be explained by the near exclusive use of drug‐eluting stents (DES), reducing the rate of restenosis, in the latter. Asymptomatic, low‐risk patients are often submitted to periodical, unuseful clinical evaluations and non‐invasive exams, whereas paradoxically, patients with higher risk features at baseline are less likely to undergo post‐PCI testing . Increasing age, male sex, and most co‐morbidities are associated with a lower likelihood of any testing after PCI .…”

“…Asymptomatic, low‐risk patients are often submitted to periodical, unuseful clinical evaluations and non‐invasive exams, whereas paradoxically, patients with higher risk features at baseline are less likely to undergo post‐PCI testing . Increasing age, male sex, and most co‐morbidities are associated with a lower likelihood of any testing after PCI . As a consequence, the revascularization rate is low on patients referred for routine stress test after PCI, with an average of 10% of patients undergoing revascularization within 90 days .…”