Routine stress testing with subsequent coronary angiography versus standard of care in high-risk patients after percutaneous coronary intervention: An updated meta-analysis of randomized controlled trials

Routine functional stress testing with subsequent coronary angiography is undertaking to detect early restenosis and guide revascularization in high-risk patients after percutaneous coronary intervention (PCI). However, the safety and efficacy of routine functional stress testing over standard care is still debatable. This meta-analysis compares routine functional stress testing vs. standard care in high-risk patients after PCI. We systematically searched PubMed, Embase, and Cochrane Central databases to identify randomized controlled trials (RCTs) that compared functional stress testing versus standard of care after PCI in high-risk patients from inception to January 2025. We calculated the risk ratios (RRs) with 95 % confidence intervals (CIs) using the random-effects model for clinical outcomes. Four RCTs with 6,290 patients, of whom 3,206 (51 %) underwent routine functional stress testing were included in our analyses. The incidence of target lesion revascularization (TLR) was higher in routine functional stress testing (RR: 1.49; 95 % CI: 1.02–2.18; p = 0.038) compared with standard care. However, no statistically significant difference was observed for individual outcomes of all-cause mortality (RR: 0.89; 95 % CI: 0.48–1.18; p = 0.198), myocardial infarction (MI) (RR: 0.62; 95 % CI: 0.31–1.24; p = 0.174), and hospitalization for any cause (RR: 1.22; 95 % CI: 0.24–6.10; p = 0.809). The risk of MACE did not significantly differ between the groups (RR: 1.11; 95 % CI: 0.82–1.51; p = 0.480). Routine functional stress testing after PCI in high-risk patients was associated with increased incidence of target lesion revascularization, without reducing the risk of major adverse cardiovascular events.