Is Routine Follow-Up Coronary Angiography Necessary After PCI?

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Since ReACT was underpowered, larger trials may be necessary to confirm benefits or harm of routine coronary angiography.
Since ReACT was underpowered, larger trials may be necessary to confirm benefits or harm of routine coronary angiography.

HealthDay News – For patients who have undergone percutaneous coronary intervention (PCI), routine follow-up coronary angiography (FUCAG) has no long-term clinical benefit, according to a study published online in JACC: Cardiovascular Interventions.

Hiroki Shiomi, MD, from Kyoto University in Japan, and colleagues examined the long-term clinical impact of routine FUCAG after PCI in a prospective multicenter open-label randomized trial. Participants who underwent PCI were randomly allocated to routine angiographic follow-up (AF), in which they received FUCAG at 8 to 12 months after PCI, or clinical follow-up alone (CF). Seven hundred patients were enrolled and randomized to AF (n=349) or CF (n=351).

The researchers found that the cumulative 5-year incidence of the primary end point (composite of death, myocardial infarction, stroke, emergency hospitalization for acute coronary syndrome, or hospitalization for heart failure) was 22.4% and 24.7% in the AF and CF groups, respectively (hazard ratio: 0.94; 95% CI, 0.67-1.31; P= .7). Within the first year, any coronary revascularization was performed more frequently in the AF group than the CF group (12.8% vs 3.8%; log-rank P <.001); over time the difference was attenuated with similar cumulative 5-year incidence (19.6% vs 18.1%; log-rank P =.92).

"Routine FUCAG cannot be recommended as a clinical strategy," the authors concluded. "However, the present study was underpowered to detect modest benefits (or harm) of routine FUCAG, and larger scale trials (especially in high-risk patients) are warranted to definitively address this issue."

Disclosures: One author disclosed ties to Boston Scientific.

Reference

Shiomi H, Morimoto T, Kitaguchi S, et al; for the ReACT investigators. The ReACT trial: randomized evaluation of routine follow-up coronary angiography after percutaneous coronary interventional trial [Published online December 17, 2016]. JACC Cardiovasc Interv. doi:10.1016/j.jcin.2016.10.018.

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