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CLINICAL STUDY

Influence of planned six-month follow-up angiography on late outcome after percutaneous coronary intervention

A randomized study

Jurriën M. ten Berg, MD^*, Johannes C. Kelder, MD^*, Maarten Jan Suttorp, MD, PhD^*, Freek W. A. Verheugt, MD, PhD, FACC and H. W. Thijs Plokker, MD, PhD, FACC^*

^* Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
Department of Cardiology, University Medical Center St. Radboud, Nijmegen, The Netherlands

Manuscript received January 29, 2001; revised manuscript received May 21, 2001, accepted June 14, 2001.

Reprint requests and correspondence: Dr. J. M. ten Berg, Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands
jurtenberg{at}wxs.nl

OBJECTIVES

The goal of this research was to study the effect of planned angiography on late clinical outcome after percutaneous coronary intervention.

BACKGROUND

It is still largely unknown whether planned follow-up angiography after coronary angioplasty influences late outcome.

METHODS

Randomization assigned 527 patients to clinical follow-up alone and 531 to clinical and six-month angiographic follow-up. The effect of planned angiography on clinical outcome at one and three years after coronary angioplasty was studied.

RESULTS

The two groups were well matched. At one year, more events occurred in the angiographic group than in the clinical group: 122 (23.2%) versus 88 (16.7%) (p = 0.01). While the incidence of death or myocardial infarction (MI) was similar at one year, the revascularization rate was higher in the angiographic group: 113 (21.3%) versus 67 (12.7%) (relative risk = 1.7, 95% confidence interval: 1.3 to 2.3, p = 0.0003). At three years, still more events had occurred in the angiographic group (146 [34.5%] vs. 114 [26.3%], p = 0.03). More reinterventions did not improve late survival. However, there was a nonsignificant reduction in MI (7 [1.3%] vs. 13 [2.5%], p = NS) and a significant improvement in functional class at the end of follow-up (freedom from angina 81% vs. 74%, p = 0.03). The effect of follow-up angiography on the reintervention rate was similar for stented and nonstented patients.

CONCLUSIONS

Planned follow-up angiography to evaluate the late results of coronary intervention led to a 1.7 times higher reintervention rate. This effect was similar for stented and nonstented patients. More reinterventions did not improve survival but tended to reduce the incidence of MI and led to a significantly better functional class at follow-up.

Abbreviations and Acronyms   BAAS = Balloon Angioplasty and Anticoagulation Study   BENESTENT-II = BElgium NEtherlands STENT II study   CABG = coronary artery bypass surgery   CI = confidence interval   MI = myocardial infarction   PCI = percutaneous coronary intervention   RR = relative risk

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