ReACT: Routine Angiographic Follow-Up After PCI

There was no long-term clinical benefit to routine follow-up coronary angiography after percutaneous coronary intervention (PCI), according to the results of the ReACT Trial presented Nov. 1 at TCT 2016 and simultaneously published in JACC: Cardiovascular Interventions.

In a prospective, multicenter, open label, randomized study, led by Hiroki Shiomi, MD, researchers assigned patients who underwent successful PCI in Japan (n=700) to either the routine angiographic follow-up group, in which they received coronary angiography at 8 – 12 months after PCI, or the clinical follow-up group. The primary endpoint was defined as a composite of death, myocardial infarction, stroke, emergency hospitalization for acute coronary syndrome, or hospitalization for congestive heart failure during a minimum of 1.5 years follow-up.

The results of the study showed that although there was a greater incidence of repeat revascularization at one year among patients in the angiographic follow-up group, during the median 4.6 years follow-up, the cumulative five-year incidence of the primary endpoint was no different between groups. There were also no significant differences between the angiographic and clinical follow-up groups in terms of any other clinical endpoints. Coronary revascularization within the first year was more frequently performed in the angiographic follow-up group than in clinical follow-up group (12.8 vs. 3.8 percent), although the difference between the two groups attenuated over time with similar cumulative five-year incidence (19.6 vs. 18.1 percent).

According to the authors, “routine follow-up coronary angiography after PCI cannot be recommended as a clinical strategy. However, the present study was underpowered to detect modest benefits or harm of routine follow-up coronary angiography, and larger-scale trials, especially in high-risk patients, are warranted to definitively address this issue.” 

Clinical Topics: Acute Coronary Syndromes, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Stable Ischemic Heart Disease, Acute Heart Failure, Interventions and ACS, Interventions and Imaging, Angiography, Nuclear Imaging, Chronic Angina

Keywords: Transcatheter Cardiovascular Therapeutics, Angina, Stable, Angiography, Coronary Vessels, Stents, Coronary Angiography, Acute Coronary Syndrome, Follow-Up Studies, Heart Failure, Hospitalization, Japan, Myocardial Infarction, Percutaneous Coronary Intervention, Prospective Studies, Research Personnel, Stroke

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