The use of functional tests and planned coronary angiography after percutaneous coronary revascularization in clinical practice. Results from the AFTER multicenter study.
BACKGROUND
The follow-up strategies after percutaneous coronary intervention (PCI) have relevant clinical and economic implications. The purpose of this prospective observational multicenter study was to evaluate the effect of clinical, procedural and organizational variables on the execution of functional testing (FT) and planned coronary angiography (CA) after PCI, and to assess the impact of American College of Cardiology (ACC)/American Heart Association (AHA) guidelines on clinical practice.


METHODS
Four hundred twenty consecutive patients undergoing PCI were categorized as class I, IIB and III indications for follow-up FT according to ACC/AHA guidelines recommendations. Furthermore, all patients were grouped according to the presence or absence of FT and/or planned CA over 12 months after PCI. Multivariable analysis was used to assess the potential predictors of test execution.


RESULTS
During the 12-month follow-up at least one test was performed in 72% of patients with class I indication, 63% of patients with class IIB indication and 75% of patients with class III indication (p=ns). A total of 283 patients (67%) underwent testing. The use of tests was associated with younger age (R.R. 0.94, C.I. 0.91+/-0.97, p<0.001), a lower number of diseased vessels (R.R. 0.60, C.I. 0.43+/-0.84, p=0.003), follow-up by the center performing PCI (R.R. 2.64, C.I. 1.43+/-4.86, p=0.002), and the specific center at which PCI was performed. Most asymptomatic patients completed their testing prematurely with respect to the risk period for restenosis.


CONCLUSIONS
The use of FT and planned CA after PCI is unrelated to patient's symptom status, and depends on patient's age and logistics. ACC/AHA guidelines have no influence in clinical practice, and test timing is not tailored to the risk period for restenosis.
Mazzarotto
Pietro
P
Interventional Cardiology Unit, San Carlo Hospital, Rome, Italy. p.mazzarotto@idi.it
Pristipino
Christian
C
Burzotta
Francesco
F
Serdoz
Roberto
R
Berni
Andrea
A
Sardella
Gennaro
G
Danesi
Alessandro
A
Di Sciascio
Germano
G
Zingales
Leone Dino
LD
Loschiavo
Paolo
P
Sciahbasi
Alessandro
A
Gioffrè
Gaetano
G
Gemelli
Francesco
F
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000592:standards; D015331:Cohort Studies; D017023:Coronary Angiography / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006334:Heart Function Tests / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome