Is Routine Follow-Up Coronary Angiography Necessary After PCI?
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.
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.