Use of routine functional resting after percutaneous transluminal coronaryangioplasty: Results from the ROSETTA Registry

Background The American College of Cardiology (ACC)/American Heart Associat ion (AHA) guidelines for exercise testing suggest that only selected groups of high-risk patients should undergo routine functional testing after perc utaneous transluminal coronary angioplasty (PTCA) for the detection of rest enosis. Objectives Our purpose was (1) to document the patterns of use of post-PTCA Functional testing and (2) to determine whether the choice of functional r esting strategy is related to clinical characteristics of patients or wheth er physicians use a similar strategy for all their patients. Methods The Routine Versus Selective Exercise Treadmill Testing After Angio plasty (ROSETTA) Registry is a prospective study examining the use of funct ional testing among 788 patients at 13 centers in 5 countries. Results During the 6-month period after a successful PTCA, 49% of patients underwent functional testing (range among centers 10%-81%). Among patients who underwent functional testing, 39% had a clinical indication and 61% had functional testing as a routine follow-up. The first functional test was p erformed a median of 7 weeks after PTCA, with 13% of patients having second tests at a median of 14 weeks and 4% having additional tests at a median o f 20 weeks. Univariate and multivariate analyses demonstrated that the chie f determinant of the use of routine Functional testing was clinical center. Aside from age (P < .0001), no baseline clinical or procedural characteris tics were consistently associated with the use of routine functional testin g after PTCA. Conclusions Physicians do not appear to be adhering to the ACC/AHA guidelin es for exercise testing regarding the routine use of post-PTCA functional t esting. None of the clinical characteristics identified by the ACC/AHA guid elines were associated with the routine use of post-PTCA functional testing , and the primary determinant of functional testing was the location of the center at which the patient had the PTCA.