TCT 2016: Follow-up coronary angiography does not provide clinical benefits following PCI

A prospective, randomized trial in Japan found that follow-up coronary angiography following successful PCI had no clinical benefits and was associated with increased early revascularization rates.

Lead researcher Hiroki Shiomi, MD, presented the findings Nov. 1 in a first report investigations session at the Transcatheter Cardiovascular Therapeutics scientific symposium in Washington, D.C.

The results were simultaneously published online in the Journal of the American College of Cardiology: Cardiovascular Interventions.

The ReACT trial enrolled 700 patients who underwent successful PCI at 22 centers in Japan between May 2010 and July 2014. Patients were randomized in a 1:1 ratio to routine angiographic follow-up or clinical follow-up alone.

The angiographic group received follow-up coronary angiography at eight and 12 months following PCI. The researchers noted that follow-up coronary angiography was commonly performed in Japan.

The two groups were well-balanced with regard to clinical, angiographic and procedural characteristics, according to the researchers. They added that 85 percent of the patients used drug-eluting stents during their PCIs.

After a median follow-up period of 4.6 years, the cumulative incidence of the primary endpoint 22.4 percent in the angiographic group and 24.7 percent in the clinical group. The primary endpoint was the composite of death, MI, stroke, emergency hospitalization for acute coronary syndrome or hospitalization for heart failure.

The cumulative five-year incidence of any coronary revascularization was 19.6 percent in the angiographic group and 18.1 percent in the clinical group, which was not a statistically significant difference. Within the first year, 12.8 percent of patients in the angiographic group and 3.8 percent of patients in the clinical group underwent coronary revascularization. That difference was statistically significant.

The researchers mentioned a few limitations of the study, including that it was underpowered to detect modest differences in the primary endpoint. They also could not address the role of routine angiographic follow-up in high-risk patients, including those with left main or multivessel coronary artery disease. In addition, they noted the results might not be generalizable to patients outside of Japan.

“In this study, routine follow-up coronary angiography after PCI, as compared with clinical follow-up alone, did not bring any significant clinical benefit,” Shiomi said in a news release. “Thus, routine follow-up coronary angiography after PCI cannot be recommended as a clinical strategy. However, the present study was underpowered to detect modest benefits or harm of [routine follow-up coronary angiography], and larger-scale trials, especially in high-risk patients, are warranted to definitively address this issue.”