Study Finds Routine Heart CT Scanning Unnecessary Post-Stenting for Left Main Coronary Artery Disease

Recent research presented at the ESC Congress 2025 has shown that routine coronary computed tomography (CCT) scans are not beneficial for follow-up after stenting procedures in patients with left main coronary artery disease. The study indicates that regular CCT monitoring at six months does not significantly reduce the risk of death, myocardial infarction (MI), unstable angina, or stent thrombosis when compared to standard symptom-based management.

The trial, named PULSE, was a multicenter, randomized controlled study involving 606 patients across Europe and South America, with an average age of 69 years. Participants were assigned either to a CCT-guided follow-up at six months or to routine management based on symptoms and ischemia. The primary endpoint was a composite of all-cause death, MI, unstable angina, or stent thrombosis over 18 months.

Findings revealed no significant difference in the primary composite endpoint between the two groups—11.9% in the CCT group versus 12.5% in the standard care group. Notably, the CCT group showed a lower incidence of spontaneous MI (0.9% vs. 4.9%), but there was an increase in revascularizations prompted by imaging findings, which did not translate into better clinical outcomes.

The lead investigator, Professor Fabrizio D'Ascenzo, stated that systematic six-month CCT follow-up did not reduce the overall risk of adverse events and suggested that routine surveillance may be unnecessary for all patients. However, the approach might still hold value for selected patients with complex anatomies or those at higher risk, especially over longer follow-up periods.

This study underscores that while CCT is a useful diagnostic tool, its routine use after PCI for left main disease does not improve survival or reduce major cardiac events, emphasizing a tailored approach to post-procedural monitoring.