Routine Angiographic Follow-up After PCI
What is the clinical impact of routine angiographic follow-up in patients undergoing percutaneous coronary intervention (PCI)?
The authors designed ReACT, a prospective, multicenter, open-label, randomized trial in which patients who underwent successful PCI were randomly assigned to planned angiographic follow-up or clinical follow-up. Planned angiography was performed at 8-12 months after PCI. The primary endpoint was defined as a composite of death, myocardial infarction, stroke, emergency hospitalization for acute coronary syndrome, or hospitalization for heart failure.
The study enrolled 700 patients at 22 participating centers over a 4-year period, of which 349 were assigned to planned angiography and 351 to clinical follow-up. During a median follow-up of 4.6 years, the cumulative 5-year incidence of the primary endpoint was 22.4% in the angiographic follow-up group and 24.7% in the clinical follow-up group (hazard ratio, 0.94; 95% confidence interval, 0.67-1.31; p = 0.70). Routine angiographic follow-up was associated with a greater likelihood of coronary revascularization within the first year (12.8% vs. 3.8%; log-rank p < 0.001), although the difference between the two groups attenuated over time (5-year incidence, 19.6% vs. 18.1%; log-rank p = 0.92).
The authors concluded that there was no benefit of routine angiographic follow-up of patients undergoing successful PCI.
Current guidelines dissuade against routine angiographic follow-up after PCI; however, this practice is not uncommon in certain countries. Although this study was underpowered (and thus statistically inconclusive), in the absence of data to the contrary, there is no logical reason to recommend routine angiographic follow-up after PCI.
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