Kim Yong Hoon, Her Ae-Young, Rha Seung-Woon, Choi Byoung Geol, Shim Minsuk, Choi Se Yeon, Byun Jae Kyeong, Li Hu, Kim Woohyeun, Kang Jun Hyuk, Choi Jah Yeon, Park Eun Jin, Park Sung-Hun, Lee Sunki, Na Jin Oh, Choi Cheol Ung, Lim Hong Euy, Kim Eung Ju, Park Chang Gyu, Seo Hong Seog, Oh Dong Joo
aDepartment of Internal Medicine, Division of Cardiology, Kangwon National University School of Medicine, Chuncheon bCardiovascular Center cDepartment of Medicine, Korea University Graduate School, Seoul, South Korea.
Coron Artery Dis. 2017 Jun;28(4):307-314. doi: 10.1097/MCA.0000000000000479.
The difference in the usefulness of routine angiographic follow-up (RAF) and clinical follow-up (CF) after a percutaneous coronary intervention (PCI) in multivessel coronary artery disease (MVD) patients has not been well clarified as yet.
A total of 642 consecutive MVD patients who underwent PCI with drug-eluting stents (DES) were enrolled. RAF was performed at 6-9 months after the index PCI (n=374) and others were medically managed and clinically followed (n=268). Patients who experienced clinical events including death, myocardial infarction (MI), and ischemia-driven PCI before 1 year were excluded. To adjust for any potential confounders, a propensity scorematched analysis was carried out using the logistic regression model and two propensity-matched groups (193 pairs, n=386, C-statistic=0.744) were generated. Cumulative clinical outcomes up to 3 years were compared between the RAF group and the CF group.
During the 3-year follow-up period, the cumulative incidence of revascularization [target lesion revascularization: odds ratio (OR), 4.21; 95% confidence interval (CI), 1.67-10.6; P=0.001) and target vessel revascularization (TVR: OR, 4.69; 95% CI, 2.00-11.0; P<0.001, target vessel revascularization: OR, 4.69; 95% CI, 2.00-1011.0; P<0.001] and major adverse cardiovascular events (composite of death, repeat PCI and MI: OR, 2.96; 95% CI, 1.62-105.42, P<0.001) were significantly higher in the RAF group compared with the CF group. However, the 3-year incidence of death (OR, 1.41; 95% CI, 0.44-104.53; P=0.558) or MI (OR, 2.58; 95% CI, 0.79-108.37; P=0.102) was not different between the two groups. In MVD patients treated with second-generation DESs, the incidence of repeat revascularization (target lesion revascularization and target vessel revascularization) was not different between the two groups.
Conclusion RAF following index PCI with DES in multivessel CAD patients was associated with increased incidence of revascularization and major adverse cardiovascular events. However, in MVD patients treated with second-generation DESs, repeat revascularization incidence was similar between two different follow-up strategies up to 3 years.
多支冠状动脉疾病（MVD）患者经皮冠状动脉介入治疗（PCI）后，常规血管造影随访（RAF）与临床随访（CF）的效用差异尚未得到充分阐明。
连续纳入642例行药物洗脱支架（DES）PCI的MVD患者。在首次PCI术后6 - 9个月进行RAF（n = 374），其他患者接受药物治疗并进行临床随访（n = 268）。排除1年内发生包括死亡、心肌梗死（MI）和缺血驱动PCI等临床事件的患者。为调整潜在混杂因素，使用逻辑回归模型进行倾向评分匹配分析，生成两个倾向匹配组（193对，n = 386，C统计量 = 0.744）。比较RAF组和CF组至3年的累积临床结局。
在3年随访期内，RAF组的血运重建累积发生率[靶病变血运重建：优势比（OR），4.21；95%置信区间（CI），1.67 - 10.6；P = 0.001]、靶血管血运重建（TVR：OR，4.69；95% CI，2.00 - 11.0；P < 0.001，靶血管血运重建：OR，4.69；95% CI，2.00 - 11.0；P < 0.001）和主要不良心血管事件（死亡、再次PCI和MI的复合事件：OR，2.96；95% CI，1.62 - 5.42，P < 0.001）显著高于CF组。然而，两组间3年的死亡（OR，1.41；95% CI，0.44 - 4.53；P = 0.558）或MI（OR，2.58；95% CI，0.79 - 8.37；P = 0.102）发生率无差异。在接受第二代DES治疗的MVD患者中，两组间再次血运重建（靶病变血运重建和靶血管血运重建）的发生率无差异。
多支冠状动脉疾病患者首次PCI后使用DES进行RAF与血运重建及主要不良心血管事件发生率增加相关。然而，在接受第二代DES治疗的MVD患者中，两种不同随访策略至3年的再次血运重建发生率相似。
