Routine Angiographic Follow-Up After Coronary Artery Disease Revascularization: Is Seeing Believing?

Abstract

According to the 2016 update from the American Heart Association (AHA), 15.5 million people above the age of 20 have coronary heart disease (CHD) in the USA. The prevalence of CHD is now almost similar in both men and women, and one American suffers from a myocardial infarction (MI) every 42 s. Recent data from randomized clinical trials and observational studies does not support the use of routine coronary angiography after revascularization in asymptomatic patients. There are some studies which show that routine angiography may have a role in left main or complex coronary interventions; however, these findings are exploratory and were not seen in randomized trials. After reviewing the data on routine angiography after coronary revascularization, we came to the conclusion that current data does not support the use of routine angiography for asymptomatic patients. However, there is a lack of randomized controlled trial in this field with only one recent trial reporting negative outcomes.

2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines

“…8,28 Routine follow-up invasive coronary angiography has been associated with increased revascularization of nonischemic intermediate lesions without an improvement in rates of subsequent cardiac death or MI. 16,17 The ReACT (Randomized Evaluation of Routine Follow-up Coronary Angiography after PCI) trial was a prospective multicenter open-label trial in Japan in which 700 patients were randomized to receive routine follow-up coronary angiography 8 to 12 months after PCI versus clinical follow-up alone. 14 During median follow-up of 4.6 years, no clinical benefit was seen for routine follow-up coronary angiography despite increased early coronary revascularization rates.…”

Genetic Variants in PHACTR1 & LPL Mediate Restenosis Risk in Coronary Artery Patients

“…Revascularization via coronary stent placed by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is a common treatment option for patients with CAD. 1 There are more than 1,000,000 PCI and 400,000 CABG procedures performed yearly to treat CAD. 2 , 3 Coronary stent implantation is widely used and reduces the early complications associated with balloon angioplasty.…”

“…The restenosis rate for saphenous vein grafts (SVG), the most common graft, is projected to be close to 2% every year. 1 While stents via either PCI or CABG remain the gold standard procedure to treat CAD, their long-term failure due to restenosis calls for deeper investigations to improve the outcome of these procedures.…”