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Impact of routine angiographic follow-up after angioplasty
H J Rupprecht1, C Espinola-Klein, R Erbel
1Medical Clinic II, Johannes Gutenberg University, Mainz, Germany.
Insights
Routine 6-month angiograms after successful percutaneous transluminal coronary angioplasty (PTCA) increase repeat PTCA rates but significantly lower 10-year mortality. This follow-up is crucial for better patient outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Controversy exists regarding the routine use of repeat coronary angiography after successful percutaneous transluminal coronary angioplasty (PTCA).
- Evaluating long-term outcomes is essential for guiding clinical practice decisions.
Purpose of the Study:
- To investigate the 10-year outcomes of patients undergoing or not undergoing routine 6-month angiographic control after successful PTCA.
- To identify predictors of adverse events in patients post-PTCA.
Main Methods:
- A 10-year follow-up study involving 400 patients who had successful PTCA.
- Patients were divided into two groups: routine 6-month angiographic control (group A, n=315) and no routine control (group B, n=85).
- Data collected via questionnaire and telephone interview; multivariate Cox regression analysis used to identify adverse event predictors.
Main Results:
- Group A showed significantly lower 10-year mortality (7% vs. 19%, P=.003) and fewer serious adverse events (24% vs. 38%, P=.02) compared to Group B.
- Absence of 6-month angiographic follow-up was an independent predictor of death (2.7 times higher mortality).
- Repeat PTCA rates were higher in Group A (28% vs. 13%, P=.012), while rates of myocardial infarction and coronary artery bypass grafting were not significantly different.
Conclusions:
- Routine 6-month angiographic control after successful PTCA is associated with a significantly lower 10-year mortality rate.
- Despite leading to more repeat PTCA procedures, routine follow-up angiography improves long-term survival outcomes.
Background:
There is an ongoing controversy as to whether repeat coronary angiography should be routinely performed after successful percutaneous transluminal coronary angioplasty (PTCA).
Methods:
We examined the 10-year outcome in 400 patients who had or had not undergone an angiographic control 6 months after successful PTCA and a subsequent event-free 6-month period. Our comparison was based on data gathered by questionnaire and telephone interview in 315 patients with (group A) and 85 patients without (group B) a routine 6-month angiographic control. Multivariate analysis (Cox model) was performed to identify predictors of adverse events.
Results:
During the 10-year follow-up period, 22 (7%) of the 315 patients in group A died, compared with 16 (19%) patients in group B (P= .003). In groups A and B, respectively, acute myocardial infarction occurred in 28 (9%) and 10 (12%) patients (not significant [NS]); coronary artery bypass grafting (CABG) was performed in 42 (13%) and 14 (16%) patients (NS); repeat PTCA was performed in 89 (28%) and 11 (13%) patients (P= .012); and serious adverse events (death, myocardial infarction, CABG) occurred in 76 (24%) and 32 (38%) patients (P= .02). Absence of a 6-month angiographic follow-up was identified as an independent predictor of death associated with a 2.7 times higher mortality rate during the 10-year follow-up period. Previous myocardial infarction increased the risk of death 2.5 times. Any increase of residual diameter stenosis by 10% was combined with a 1.4 times higher mortality rate. The chance of bypass surgery was higher in patients with multivessel disease (2.9 times), in patients with unstable angina (2.1 times), and in case of an increase of residual diameter stenosis by 10% (1.3 times). No predictor for the risk of myocardial infarction was found. Angiographic follow-up increased the likelihood of PTCA 2.5 times.
Conclusions:
A routinely performed angiographic control 6 months after successful PTCA is associated with a significantly higher rate of repeat PTCA but, most important, is correlated with a significantly lower mortality rate during the 10-year follow-up period.