The ReACT Trial: Randomized Evaluation of Routine Follow-up Coronary Angiography After Percutaneous Coronary...

The long-term effects of routine follow-up coronary angiography after percutaneous coronary intervention remain unclear. Prior research has shown that PCI improves blood flow in coronary arteries, but the role of routine angiographic follow-up is uncertain. No prior work had resolved whether such follow-up leads to better patient outcomes. This gap motivated a need for real-world clinical trials. Existing studies have not evaluated the impact of routine follow-up angiography in daily practice. Established knowledge includes the benefits of PCI in treating coronary artery disease. However, the optimal follow-up strategy remains debated. This paper's contribution is a randomized trial assessing the clinical impact of routine follow-up angiography in a Japanese population.

The ReACT Trial aimed to assess the long-term clinical impact of routine follow-up coronary angiography after PCI in real-world clinical settings. The study sought to determine if routine angiographic follow-up improves patient outcomes compared to clinical follow-up alone. Researchers focused on evaluating the effectiveness of this strategy in a Japanese population. The primary goal was to compare two follow-up approaches after PCI. The study aimed to measure the incidence of major adverse cardiac events. The trial was designed to reflect typical clinical practice in Japan. The purpose was to provide evidence for or against routine angiographic follow-up. This study addressed an important gap in post-PCI follow-up protocols.

The ReACT Trial was a prospective, multicenter, open-label, randomized study. Participants were patients who underwent successful PCI and were randomly assigned to two groups. One group received routine follow-up coronary angiography at 8 to 12 months post-PCI. The other group received clinical follow-up alone without routine angiography. The primary endpoint was a composite of death, myocardial infarction, stroke, emergency hospitalization for acute coronary syndrome, or heart failure hospitalization. Follow-up lasted a minimum of 1.5 years with a median of 4.6 years. The study enrolled 700 patients across 22 centers in Japan. The trial used randomization to assign patients to either the AF or CF group.

The cumulative 5-year incidence of the primary endpoint was 22.4% in the AF group and 24.7% in the CF group. The hazard ratio was 0.94 with a 95% confidence interval of 0.67 to 1.31. No statistically significant difference was observed between the two groups (p = 0.70). Early coronary revascularization rates were higher in the AF group during the first year. The AF group had a 12.8% revascularization rate compared to 3.8% in the CF group. However, the difference between groups diminished over time. The 5-year cumulative incidence of revascularization was 19.6% in the AF group and 18.1% in the CF group. No clinical benefits were observed from routine follow-up coronary angiography.

The ReACT Trial found no significant clinical benefit from routine follow-up coronary angiography after PCI. The authors stated that routine angiographic follow-up did not reduce the incidence of major adverse cardiac events. The study concluded that early coronary revascularization rates were higher in the AF group. However, the difference in revascularization rates disappeared by the 5-year mark. The authors proposed that routine follow-up angiography may not improve long-term outcomes. The findings suggest that clinical follow-up alone may be sufficient after PCI. The study emphasized the importance of evaluating real-world clinical practices. These results may influence future guidelines on post-PCI follow-up strategies.