Author + information
- Received August 5, 2009
- Revision received December 8, 2009
- Accepted January 8, 2010
- Published online April 1, 2010.
- Takahiro Uchida, MD†,⁎ (, )
- Jeffrey Popma, MD⁎,
- Gregg W. Stone, MD‡,
- Stephen G. Ellis, MD§,
- Mark A. Turco, MD∥,
- John A. Ormiston, MBChB¶,
- Toshiya Muramatsu, MD#,
- Masato Nakamura, MD⁎⁎,
- Shinsuke Nanto, MD, PhD††,
- Hiroyoshi Yokoi, MD‡‡ and
- Donald S. Baim, MD†
- ↵⁎Reprint requests and correspondence:
Dr. Takahiro Uchida, 100 Boston Scientific Way, Mailstop M-70, Marlborough, Massachusetts 01752
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 ≥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.
This study was supported by the Boston Scientific Corporation. Drs. Uchida and Baim are full-time employees of Boston Scientific and hold stock or equity in the company. Dr. Popma has received research grants from and is a member of the Medical Advisory Board of Boston Scientific. Drs. Stone and Ormiston disclose their participation on the Scientific Advisory Boards of Boston Scientific and Abbott Vascular, and Dr. Ellis has also participated on the Scientific Advisory Board of Boston Scientific. Dr. Turco is a member of the Speakers' Bureau and Advisory Boards of Boston Scientific, Cordis, and Medtronic.
- Received August 5, 2009.
- Revision received December 8, 2009.
- Accepted January 8, 2010.
- American College of Cardiology Foundation