No benefit of routine follow-up angiography after PCI
medwireNews: Results of the ReACT trial suggest no additional benefit with follow-up coronary angiography after percutaneous coronary intervention (PCI) in daily clinical practice.
“Routine [follow-up coronary angiography] after PCI is still commonly performed as usual care in Japan,” say Takeshi Kimura (Kyoto University Graduate School of Medicine, Japan) and colleagues. However, based on the present results, it “cannot be recommended as a clinical strategy,” they add.
In the multicenter open-label ReACT (Evaluation of Routine Follow-up Coronary Angiography After Percutaneous Coronary Intervention Trial), all-comer patients undergoing successful PCI in 22 Japanese centers were randomly assigned to receive either routine angiographic follow-up 8–12 months after the procedure or clinical follow-up alone.
After a median follow-up of 4.6 years, 22.4% of 349 patients receiving angiographic follow-up experienced the composite endpoint of death, myocardial infarction, stroke, emergency hospitalization for acute coronary syndromes, or hospitalization for heart failure, compared with 24.7% of 351 patients undergoing clinical follow-up alone, a nonsignificant difference.
Although coronary revascularization within the first year of PCI was performed more frequently in patients receiving angiographic versus clinical follow-up, with rates of 12.8% versus 3.8%, the difference “attenuated over time,” with 5-year cumulative incidence rates of 19.6% and 18.1%, respectively, report the team in JACC: Cardiovascular Interventions.
And in subgroup analyses, the researchers observed no benefit of angiographic relative to clinical follow-up in various patient subsets, including those classified as “high risk” by the presence of at least one high-risk feature, such as left main coronary artery disease, bifurcation lesion, multivessel disease, and total stent length of 40 mm or greater.
They observe that these findings are in accordance with previous studies involving “patients with relatively low risk profile in terms of comorbidity and lesion complexity,” and suggest no benefit of follow-up angiography among “high-risk patients in real clinical practice.”
However, the authors of an accompanying editorial comment, Rishi Puri (Québec Heart and Lung Institute, Québec City, Canada) and colleagues, note that “several caveats of this trial warrant consideration, prior to us putting the final nail in the coffin for surveillance coronary angiography during routine clinical practice.”
They point out that the trial was underpowered, and included an insufficient number of patients with high-risk lesions in whom routine follow-up angiography “may indeed harbor a specific niche.”
And the study authors agree, suggesting that “the current trial result might be ‘inconclusive’ rather than ‘negative,’ warranting future, larger scale studies.” They add that additional studies should be conducted “in high-risk subsets of patients, such as those with left main or multivessel coronary artery disease.”
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