App-based lifestyle modification after percutaneous coronary intervention: A multicenter randomized controlled trial

Long-term outcomes after percutaneous coronary intervention (PCI) remain suboptimal, mainly due to progression of non-target lesion stenosis. Lifestyle modification can attenuate these outcomes, and digital health interventions may provide an alternative to standard care. We conducted a multicenter, open-label, randomized controlled trial in post-PCI patients (n = 152). Subjects were assigned to a 14-week app-based lifestyle modification program using IoT devices or to usual care. The primary endpoint was the proportion achieving ≥ 10% improvement in peak oxygen uptake (VO₂). Secondary endpoints included achievement of guideline targets for four major coronary risk factors (CRFs) (blood pressure, lipid profile, HbA1c, body weight), moderate-to-vigorous physical activity, quality of life, and adherence. A modified intention-to-treat analysis was applied. Of 152 patients (75 for intervention and 77 for control, mean age 60.3 years, 90.1% male), 137 completed follow-up. Both groups showed similar proportions achieving ≥ 10% improvement in peak VO₂ (41% vs. 39%, p = 0.786). Lipid control was better in the intervention group (56.0% vs. 39.5%, p = 0.042), while other risk factors showed no significant differences. Contrary to these, a complete-case analysis using different metrics indicated potential superiority of CRF management in the intervention group. Based on the above findings, although the comparative effectiveness of the app could not be clearly determined, the observed trends suggest substantial potential for future clinical use. This potential is expected to become clearer with improved app quality and more rigorous outcome measures.