Routine Angiographic Follow-Up versus Clinical Follow-Up after Percutaneous Coronary Intervention in Acute Myocardial Infarction

• Published in: Yonsei medical journal Vol. 58; no. 4; pp. 720 - 730
• Main Authors: Kim, Yong Hoon, Her, Ae Young, Rha, Seung Woon, Choi, Byoung Geol, Shim, Minsuk, Choi, Se Yeon, Byun, Jae Kyeong, Li, Hu, Kim, Woohyeun, Kang, Jun Hyuk, Choi, Jah Yeon, Park, Eun Jin, Park, Sung Hun, Lee, Sunki, Na, Jin Oh, Choi, Cheol Ung, Lim, Hong Euy, Kim, Eung Ju, Park, Chang Gyu, Seo, Hong Seog, Oh, Dong Joo
• Format: Journal Article
• Language: English
• Published: Korea (South) Yonsei University College of Medicine 01.07.2017; 연세대학교의과대학
• Subjects: Coronary Angiography; Female; Follow-Up Studies; Humans; Incidence; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - surgery; Original; Percutaneous Coronary Intervention - adverse effects; Propensity Score; Proportional Hazards Models; Treatment Outcome; 의학일반; Acute myocardial infarction; outcomes; coronary angiography
• ISSN: 0513-5796; 1976-2437
• DOI: 10.3349/ymj.2017.58.4.720

Differences in the utility of routine angiographic follow-up (RAF) and clinical follow-up (CF) after percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) are not well understood. The present study aimed to compare the 3-year clinical outcomes of RAF and CF in AMI patients who underwent PCI with drug-eluting stents (DES). A total of 774 consecutive AMI patients who underwent PCI with DES were enrolled. RAF was performed at 6 to 9 months after index PCI (n=425). The remaining patients were medically managed and clinically followed (n=349); symptom-driven events were captured. To adjust for any potential confounders, a propensity score matched analysis was performed using a logistic regression model, and two propensity-matched groups (248 pairs, n=496, C-statistic=0.739) were generated. Cumulative clinical outcomes up to 3 years were compared between RAF and CF groups. During the 3-year follow-up period, the cumulative incidences of revascularization [target lesion revascularization: hazard ratio (HR), 2.40; 95% confidence interval (CI), 1.18-4.85; p=0.015, target vessel revascularization (TVR): HR, 3.33; 95% CI, 1.69-6.58; p=0.001, non-TVR: HR, 5.64; 95% CI, 1.90-16.6; p=0.002] and major adverse cardiac events (MACE; HR, 3.32; 95% CI, 1.92-5.73; p<0.001) were significantly higher in the RAF group than the CF group. However, the 3-year incidences of death and myocardial infarction were not different between the two groups. RAF following index PCI with DES in AMI patients was associated with increased incidences of revascularization and MACE. Therefore, CF seems warranted for asymptomatic patients after PCI for AMI.