title: The role of angiographic follow-up after percutaneous coronary intervention.
abstract: In the early days of coronary angioplasty, follow-up coronary angiography was often performed to assess restenosis. Angiographic restenosis has been shown to be associated with worse clinical outcomes, though the exact causality has yet to be determined. Numerous studies have repeatedly demonstrated that routine follow-up coronary angiography increases the incidence of target lesion revascularization without a clear reduction in mortality or myocardial infarction. Despite the lack of proven benefit of angiographic follow-up, routine follow-up coronary angiography is still being performed in certain countries and facilities. There are several factors that might explain the lack of benefit of angiographic follow-up: 1) lower incidence of stent failure in the current drug-eluting stent era has attenuated the net clinical benefit of follow-up angiography. 2) Angiographic restenosis might not lead to myocardial ischemia. 3) Patients that do have functionally significant restenosis are often referred for coronary angiography due to clinical indications such as intractable angina. 4) Absence of restenosis at the time of follow-up angiography does not exclude future restenosis. The absence of proven benefit in unselected populations does not necessarily preclude the presence of benefit in selected population, and there may be a subgroup of patients who can benefit from angiographic follow-up such as those with a large myocardial ischemic territory or those at very high risk of restenosis. Until there is more clinical evidence with respect to follow-up angiography, the decision of whether or not to perform it routinely in selected high-risk population should entail an in-depth discussion with the patient.
authors.affiliation: Department of Internal Medicine, Mount Sinai Beth Israel, New York, USA. Electronic address: misumidanaoki@gmail.com.
authors.forename: Naoki
authors.initials: N
authors.lastname: Misumida
authors.affiliation: Department of Internal Medicine, Mount Sinai Beth Israel, New York, USA.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Aoi
authors.affiliation: Department of Cardiology, Mount Sinai Beth Israel, New York, USA.
authors.forename: Madeeha
authors.initials: M
authors.lastname: Saeed
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Ota
authors.affiliation: Department of Cardiovascular Surgery, Toyota Memorial Hospital, Toyota, Japan.
authors.forename: Tadahito
authors.initials: T
authors.lastname: Eda
authors.affiliation: Department of Cardiology, Toyota Memorial Hospital, Toyota, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Umeda
authors.affiliation: Department of Cardiology, Mount Sinai Beth Israel, New York, USA.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Kanei
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D023903:Coronary Restenosis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005500:Follow-Up Studies; D006801:Humans; D009203:Myocardial Infarction / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D013997:Time Factors
keywords: Bare-metal stent; Coronary angiography; Coronary artery disease; Drug-eluting stent; Percutaneous coronary intervention; Restenosis