|The clinical impact of routine angiographic follow-up in randomized trials of drug-eluting stents: a critical assessment of "oculostenotic" reintervention in patients with intermediate lesions.|
|PMID: 20398868 Owner: NLM Status: MEDLINE|
|OBJECTIVES: The aim of this study was to study the long-term clinical effects of routine angiographic follow-up and related reintervention after drug-eluting stenting.
BACKGROUND: Prior stent trials have shown that protocol-mandated angiographic follow-up increases repeat interventions compared with clinical follow-up alone. The long-term clinical impact of this practice is unknown.
METHODS: Long-term outcomes of patients assigned to routine angiographic follow-up in 3 large-scale TAXUS (Boston Scientific, Natick, Massachusetts) trials were compared with patients assigned to clinical follow-up alone, in a propensity score-adjusted patient-level meta-analysis. Outcomes were also compared in patients with treated versus untreated nonischemic intermediate lesions (quantitative angiographic stenosis between >or=40% and <70%) detected at angiographic follow-up.
RESULTS: Target lesion revascularization (TLR) rates at 5 years were significantly higher in the angiographic compared with clinical follow-up cohort (18.3% vs. 11.1%, p < 0.001). This was due to more frequent treatment of intermediate lesions, but there was no associated reduction in rates of cardiac death or myocardial infarction (8.9% vs. 8.8%, p = 0.93). Of patients with nonischemic intermediate lesions, 17% who were not revascularized at the time of angiographic follow-up had a subsequent TLR, whereas 7% of patients who had TLR at this follow-up angiogram required additional revascularization during long-term follow-up.
CONCLUSIONS: A strategy of routine angiographic follow-up increases oculostenotic revascularization of nonischemic intermediate lesions without affecting subsequent rates of cardiac death or myocardial infarction, and TLR was not required in 83% of those lesions. A conservative approach, in which repeat angiography is limited to patients with recurrent ischemia or progressive symptoms, minimizes repeat revascularization of nonischemic intermediate lesions and optimizes long-term event-free survival after drug-eluting stent implantation.
|Takahiro Uchida; Jeffrey Popma; Gregg W Stone; Stephen G Ellis; Mark A Turco; John A Ormiston; Toshiya Muramatsu; Masato Nakamura; Shinsuke Nanto; Hiroyoshi Yokoi; Donald S Baim|
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|Type: Journal Article; Multicenter Study|
|Title: JACC. Cardiovascular interventions Volume: 3 ISSN: 1876-7605 ISO Abbreviation: JACC Cardiovasc Interv Publication Date: 2010 Apr|
|Created Date: 2010-04-19 Completed Date: 2010-07-09 Revised Date: 2014-09-05|
Medline Journal Info:
|Nlm Unique ID: 101467004 Medline TA: JACC Cardiovasc Interv Country: United States|
|Languages: eng Pagination: 403-11 Citation Subset: IM|
|Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.|
|APA/MLA Format Download EndNote Download BibTex|
Angioplasty, Balloon, Coronary / adverse effects, instrumentation*, mortality
Coronary Restenosis / etiology, mortality, radiography*, therapy*
Coronary Stenosis / mortality, radiography*, therapy*
Myocardial Infarction / etiology, radiography
Myocardial Ischemia / etiology, radiography
Predictive Value of Tests
Proportional Hazards Models
Randomized Controlled Trials as Topic*
Severity of Illness Index
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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