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Comparative Study
. 2017 Jul;58(4):720-730.
doi: 10.3349/ymj.2017.58.4.720.

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

Yong Hoon Kim  1 , Ae Young Her  1 , Seung Woon Rha  2 , Byoung Geol Choi  3 , Minsuk Shim  3 , Se Yeon Choi  3 , Jae Kyeong Byun  3 , Hu Li  3 , Woohyeun Kim  4 , Jun Hyuk Kang  4 , Jah Yeon Choi  4 , Eun Jin Park  4 , Sung Hun Park  5 , Sunki Lee  4 , Jin Oh Na  4 , Cheol Ung Choi  4 , Hong Euy Lim  4 , Eung Ju Kim  4 , Chang Gyu Park  4 , Hong Seog Seo  4 , Dong Joo Oh  4
Affiliations
Comparative Study

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

Yong Hoon Kim et al. Yonsei Med J. 2017 Jul.

Abstract

Purpose: 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).

Materials and methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Acute myocardial infarction; coronary angiography; outcomes.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1. Schematic presentation of flow sheet of this study. PCI, percutaneous coronary intervention; CAG, coronary angiography; MI, myocardial infarction.
Fig. 2
Fig. 2. Flow chart of study number of patients. AMI, acute myocardial infarction; MI, myocardial infarction; CAG, coronary angiography; RAF, routine angiographic follow-up; CF, clinical follow-up.
Fig. 3
Fig. 3. Propensity score adjusted Cox-regression analysis for cardiac death and myocardial infarction, and any revascularization up to 3-year in various subgroups. RAF, routine angiographic follow-up; CF, clinical follow-up; STEMI, ST-segment elevation myocardial infarction; CI, confidence interval.
Fig. 4
Fig. 4. Kaplan-Meier curved analysis for TLR and TVR. (A) Total cumulative events curve of TLR and TVR. (B) Cumulative events curve up to 3-year after the nested control period. TLR, target lesion revascularization; TVR, target vessel revascularization; RAF, routine angiographic follow-up; CF, clinical follow-up; PCI, percutaneous coronary intervention.
See this image and copyright information in PMC

References

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