Author + information
- Hiroki Shiomi, MD and
- Takeshi Kimura, MD∗ ()
- ↵∗Kyoto University Graduate School of Medicine, Department of Cardiovascular Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
We thank Bertaina and colleagues for their interest in our study evaluating the clinical impact of routine coronary angiography (CAG) after percutaneous coronary intervention (PCI) (1). As we stated in our paper, we agree with Bertaina and colleagues that our study was underpowered to make a definitive conclusion regarding the clinical impact of routine follow-up CAG after PCI, especially for high-risk patients such as those with left main disease, complex coronary artery disease (CAD), and acute coronary syndrome. We also agree with the importance of longer follow-up to detect the potential benefit of routine follow-up CAG.
Bertaina and colleagues stress potential benefits of routine follow-up CAG in patients with acute coronary syndrome. We think, however, that it remains unclear whether we should consider patients with acute coronary syndrome and stable CAD differently with respect to management beyond the acute phase of intervention, such as the timing of routine follow-up CAG (typically 8 months to 1 year), because our large-scale cohort reported that patients with acute myocardial infarction compared with those without acute myocardial infarction were associated with similar late cardiovascular event risk beyond 3 months after PCI (2).
Regarding complex CAD such as left main disease and chronic total occlusion, too few patients with a wide 95% confidence interval in our study make it difficult to discuss any potential benefits of routine follow-up CAG in this important category of patients. While expanding the indication of PCI for complex CAD, appropriate management for these patients after PCI is a clinically relevant issue.
However, our study showed no apparent clinical benefits of “routine” follow-up CAG in 700 patients with a median follow-up duration of 4.6 years. Considering the invasive nature of CAG and increased medical expenses, “routine” follow-up CAG after PCI, which is still performed commonly in Japan, is no longer recommended in the majority of post-PCI patients. At the same time, however, we agree with the notion that a window of investigating the potential benefits of follow-up CAG after PCI in “selected” patients is still open.
Please note: Both authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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