Document Detail


Impact of routine angiographic follow-up after angioplasty.
MedLine Citation:
PMID:  9778063     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: There is an ongoing controversy as to whether repeat coronary angiography should be routinely performed after successful percutaneous transluminal coronary angioplasty (PTCA). METHODS: We examined the 10-year outcome in 400 patients who had or had not undergone an angiographic control 6 months after successful PTCA and a subsequent event-free 6-month period. Our comparison was based on data gathered by questionnaire and telephone interview in 315 patients with (group A) and 85 patients without (group B) a routine 6-month angiographic control. Multivariate 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%) and 11 (13%) patients (P= .012); and serious adverse events (death, myocardial infarction, CABG) occurred in 76 (24%) and 32 (38%) patients (P= .02). Absence of a 6-month angiographic follow-up was identified as an independent predictor of death associated with a 2.7 times higher mortality rate during the 10-year follow-up period. Previous myocardial infarction increased the risk of death 2.5 times. Any increase of residual diameter stenosis by 10% was combined with a 1.4 times higher mortality 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 10% (1.3 times). No predictor for the risk of myocardial infarction was found. Angiographic follow-up increased the likelihood of PTCA 2.5 times. CONCLUSIONS: A routinely performed angiographic control 6 months after successful PTCA is associated with a significantly higher rate of repeat PTCA but, most important, is correlated with a significantly lower mortality rate during the 10-year follow-up period.
Authors:
H J Rupprecht; C Espinola-Klein; R Erbel; B Nafe; R Brennecke; U Dietz; J Meyer
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American heart journal     Volume:  136     ISSN:  0002-8703     ISO Abbreviation:  Am. Heart J.     Publication Date:  1998 Oct 
Date Detail:
Created Date:  1998-11-04     Completed Date:  1998-11-04     Revised Date:  2006-02-27    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  613-9     Citation Subset:  AIM; IM    
Affiliation:
Medical Clinic II, Johannes Gutenberg University, Mainz, Germany.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Angioplasty, Transluminal, Percutaneous Coronary*
Coronary Angiography*
Disease-Free Survival
Female
Humans
Life Tables
Male
Middle Aged
Myocardial Infarction / mortality,  prevention & control*,  radiography*
Proportional Hazards Models
Questionnaires
Unnecessary Procedures
Comments/Corrections
Comment In:
Am Heart J. 1998 Oct;136(4 Pt 1):576-7   [PMID:  9778059 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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