IMPACT OF ROUTINE ANGIOGRAPHIC FOLLOW-UP AFTER ANGIOPLASTY

Background There is an ongoing controversy as to whether repeat corona ry angiography should be routinely performed after successful percutan eous transluminal coronary angioplasty (PTCA). Methods We examined the 10-year outcome in 400 patients who had or had not undergone an angio graphic control 6 months after successful PTCA and a subsequent event- free 6-month period. Our comparison was based on data gathered by ques tionnaire and telephone interview in 315 patients with (group A) and 8 5 patients without (group B) a routine 6-month angiographic control. M ultivariate 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%) a nd 11 (13%) patients (P=.012); and serious adverse events (death, myoc ardial infarction, CABG) occurred in 76 (24%) and 32 (38%) patients (P =.02). Absence of a 6-month angiographic follow-up was identified as a n independent predictor of death associated with a 2.7 times higher mo rtality rate during the 10-year follow-up period. Previous myocardial infarction increased the risk of death 2.5 times. Any increase of resi dual diameter stenosis by 10% was combined with a 1.4 times higher mor tality 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 1 0% (1.3 times). No predictor for the risk of myocardial infarction was found. Angiographic follow-up increased the likelihood of PTCA 2.5 ti mes. Conclusions A routinely performed angiographic control 6 months a fter successful PTCA is associated with a significantly higher rate of repeat PTCA but, most important, is correlated with a significantly l ower mortality rate during the 10-year follow-up period.