Impact of routine angiographic follow-up on long-term clinical outcomes in patients with multivessel disease underwent successful percutaneous coronary intervention
S Rha, S Y Choi, J K Byun, B G Choi, Y J Lee, A P Baskoro, A R Partama, W Chu, S Park, E J Park, D O Kang, C U ChoiAbstract
Background
Routine angiographic follow-up (RAF) after drug-eluting stent (DES) implantation generally does not improve clinical outcomes and may increase revascularization rates. However, patients with multivessel disease (MVD) may require closer monitoring due to worse clinical outcomes compared with those with single-vessel disease. We evaluated the impact of RAF on long-term clinical outcomes in patients with MVD treated with DES.
Methods
This study included 1,774 patients with MVD treated with DES between January 2004 and June 2021. Patients who experienced unexpected death, recurrent myocardial infarction, or revascularization within 6 months post-percutaneous coronary intervention (PCI) were excluded. RAF was defined as scheduled angiography performed at the physician's discretion. Patients were categorized into two groups: the clinical follow-up (CF) group (n = 1,024) and the RAF group (n = 750). We compared 5-year major clinical outcomes between the groups using propensity score matching (PSM) to adjust for baseline confounders.
Results
After PSM, 624 matched pairs were generated, with well-balanced baseline characteristics between the CF and RAF groups. Up to 5 years, the RAF group had significantly higher rates of target lesion revascularization (HR: 1.97, 95% CI: 1.29–3.01) and target vessel revascularization (HR: 1.75, 95% CI: 1.25–2.46), but showed a trend toward lower all-cause mortality (HR: 0.61, 95% CI: 0.37–1.01, P = 0.055). In a landmark analysis beyond 1 year, the RAF group showed no significant difference in repeat PCI, but demonstrated significantly lower all-cause mortality (HR: 0.54, 95% CI: 0.31–0.94), as well as lower risks of major adverse cardiac events (MACE; HR: 0.67, 95% CI: 0.48–0.95) and major adverse cardiac and cerebrovascular events (MACCE; HR: 0.69, 95% CI: 0.50–0.95) compared with the CF group.
Conclusions
In patients with MVD treated with DES, RAF was associated with higher revascularization rates compared to CF. However, RAF may be associated with improved survival and better long-term composite clinical outcomes.RAF_MVD_PCI -Rha.pngFor image description, please refer to the figure legend and surrounding text.