Routine Or Selective Stress Testing After Revascularization: ROSSTAR Trial RCT Outline (ROSSTAR)

The ROSSTAR trial is a pragmatic trial that will directly compare the strategies of routine and selective stress imaging testing (with radionuclide imaging (RNI)) late after PCI or CABG in asymptomatic patients. The study will be a single center trial based at the Jewish General Hospital (JGH), a McGill University teaching hospital (Montreal, Quebec). A total of 1100 patients who are either >5 years post-CABG or >2 years post-PCI will be randomized. Half of the patients will be randomized to a routine RNI testing, and the other half to selective RNI testing.

There is no consensus in current guidelines regarding the role of stress imaging testing late after revascularization. The issue to be resolved by the trial is whether routine stress imaging testing (stress test with nuclear perfusion imaging) benefits patients late after percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). What are the principal research questions to be addressed? Is a strategy of routine stress imaging testing late after PCI or CABG associated with lower clinical event rates than a strategy of selective stress imaging testing? Is a strategy of routine stress imaging testing late after PCI or CABG associated with better quality of life than a strategy of selective stress imaging testing? What are the resources utilization associated with routine vs. selective stress imaging testing? What is the primary hypothesis? The primary hypothesis is that routine stress imaging testing late after PCI or CABG is associated with lower clinical event rates than a strategy of selective stress imaging testing.

Myocardial Infarction, Physiological Stress Test, Nuclear Image Perfusion, Angioplasty, Coronary Artery Bypass Graft, Percutaneous Coronary Intervention, Angina, Ischemia

Patient receives standard observation, i.e. only do a nuclear imaging stress test if symptoms present themselves over the course of 3 years.

Patient receives standard observation i.e. only do a nuclear imaging stress test if symptoms present themselves over the course of 3 years

Total number of hospital days for cardiac admissions, further invasive and non-invasive testing, and revascularization procedures

Inclusion Criteria: 1.Patients who have undergone CABG or PCI. 2.CABG surgery occurred >5 years and PCI >2 years prior to randomization. 3.Patients must have had at least one SVG in the CABG group. 4.Patients are asymptomatic or have minimal chronic anginal symptoms. Exclusion Criteria: 1.Participation in a conflicting clinical study. 2.RNI testing already planned or performed within the past 12 months. 3.Unable to give informed consent. 4.Contraindications to or inability to perform exercise treadmill testing or pharmacological testing. 5.Medical condition with a prognosis of less than 3.25 years. 6.Likely to be unavailable for follow-up. 7.Unable to read and understand English or French.

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