Yonsei Med J.  2017 Jul;58(4):720-730. 10.3349/ymj.2017.58.4.720.

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

• Kim YH
• Her AY
• Rha SW
• Choi BG
• Shim M
• Choi SY
• Byun JK
• Li H
• Kim W
• Kang JH
• Choi JY
• Park EJ
• Park SH
• Lee S
• Na JO
• Choi CU
• Lim HE
• Kim EJ
• Park CG
• Seo HS
• Oh DJ

• KMID: 2419076
• DOI: http://doi.org/10.3349/ymj.2017.58.4.720

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.

Keyword

Acute myocardial infarction; coronary angiography; outcomes

MeSH Terms

*Coronary Angiography
Female
Follow-Up Studies
Humans
Incidence
Kaplan-Meier Estimate
Logistic Models
Male
Middle Aged
Myocardial Infarction/*diagnostic imaging/*surgery
Percutaneous Coronary Intervention/adverse effects
Propensity Score
Proportional Hazards Models
Treatment Outcome

Figure

• 

  Fig. 1 Schematic presentation of flow sheet of this study. PCI, percutaneous coronary intervention; CAG, coronary angiography; MI, myocardial infarction.

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  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.

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  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.

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  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.

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