Run 6-month angiogram routinely after PTCA?

Study concludes yes, but controversy continues

There is ongoing controversy as to whether repeat coronary angiography should be routinely performed after successful percutaneous transluminal coronary angioplasty (PTCA). Do the costs outweigh its subsequent benefits?

A recently reported German study demonstrates that patients who undergo a follow-up angiogram six months after their angioplasty have a significantly lower subsequent risk of death and other adverse events than patients who do not undergo the follow-up procedure.

400-patient study reports low mortality rate

Investigators identified 400 patients who underwent successful single-vessel PTCA without adverse cardiac events, defining "success" as a decrease in stenosis of more than 20%. All procedures were performed at a center that routinely schedules patients for angiography six months after successful angioplasty. About 80% of the patients had complied with this recommendation, and their mortality rate was 7% over a 10-year follow-up period. The rate of three serious adverse events combined — death, infarction, or bypass surgery — was 24%. The rates were significantly worse among patients who did not undergo angiography — 19% and 38%, respectively.

Repeated angiography helps survival

The researchers’ conclusion: "A routinely performed angiographic control six 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."

"Angiographic follow-up was the most important predictor of long-term survival," the team reported.1 There was a 2.7-fold increase in mortality rate in patients without angiographic follow-up. Patients who underwent angiography were 2.5 times more likely to undergo repeat angioplasty than patients who did not have the follow-up examination, perhaps explaining the survival advantage in the angiography group.

In an accompanying editorial, experts point out that much has changed since the study cohort underwent angioplasty in the mid-1980s. Both techniques and the hardware of angioplasty have improved, and intracoronary stenting has changed the scenario significantly, and those factors must be taken into account.

Reference

1. Rupprecht HJ, Espinola-Klein C, Brennecke R, et al. Impact of routine angiographic follow-up after angioplasty. Am Heart J 1998; 136:576-577,613-619.