The Aggressive Diagnosis of Restenosis (ADORE) Trial Mark J. Eisenberg McGill University, Montreal, Quebec, Canada Patients who undergo percutaneous coronary intervention (PCI) are at risk for restenosis of the previously occluded vessel. The results of this study clearly demonstrate that routine diagnostic monitoring for evidence of restenosis after PCI does not confer any clinical benefit compared with testing patients only if and when symptoms of ischemia develop. Dr. Eisenberg began by observing there are more than 700,000 percutaneous coronary intervention (PCI) procedures done every year in North America and more than 175,000 cases of restenosis following PCI. There is no substantial consensus among cardiologists regarding follow-up for patients after PCI: Should routine testing for evidence of restenosis be done, or should patients be tested only if and when symptoms of ischemia develop to suggest the possibility of reocclusion? There are very few data in the medical literature to guide us in resolving this question. "We saw a need for reliable clinical data to help us deal with this common and important question, and we designed and executed this clinical trial in an attempt to provide such data." In this study, 348 patients who underwent PCI were enrolled. Of that total, 172 were randomized to the routine diagnostic study group and 176 to the "selective" or "clinically driven" strategy. Patients were followed for 9 months, and those in the routine diagnostic studies group underwent exercise testing 6 weeks after PCI and exercise testing plus a nuclear cardiography scan 6 months after PCI. The results were surprising: The routine studies group accounted for 94% of all diagnostic testing done -- fifteen times more than the number of tests done for the clinically driven studies group. Interestingly, although there were many positive tests in the routine studies group (more than 30%), the rates of cardiac procedures done were similar in the two groups. Dr. Eisenberg explained: "We were concerned that a high rate of positive tests in a group undergoing frequent diagnostic studies would translate into a large number of repeat revascularization procedures. However, not all positive results are the same, and apparently the cardiologists were acting appropriately in deciding which positive tests served as indications for a revascularization procedure, and which did not." In general, the two approaches were similar in all measured outcomes. Several questionnaires were used to evaluate health-related Quality of Life, and results of these measures were similar for both groups. In terms of survival, the two groups were similar, with a trend toward poorer survival in the routine studies group. Dr. Eisenberg concluded: "Overall, there is no greater clinical benefit associated with routine testing for evidence of restenosis after PCI compared with symptom-based testing. This study was not sufficiently powerful to distinguish between higher-risk and lower-risk patients, but we are looking into that issue in an ongoing study." Reporter: Andre Weinberger, MD Copyright 2000-2013 by HESCO International, Ltd. All rights reserved.