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01.03.2018 | Ischemic Heart Disease (D Mukherjee, Section Editor) | Ausgabe 3/2018

Current Cardiology Reports 3/2018

Routine Angiographic Follow-Up After Coronary Artery Disease Revascularization: Is Seeing Believing?

Zeitschrift:
Current Cardiology Reports > Ausgabe 3/2018
Autoren:
Harsh Agrawal, Mohamed Teleb, Saba Lahsaei, Luis Carbajal, Ruben Montanez, Joseph P. Carrozza Jr
Wichtige Hinweise
This article is part of the Topical Collection on Ischemic Heart Disease

Abstract

Purpose of the Review

Coronary artery disease is a major cause of mortality and morbidity in the world, and PCI and CABG account for over a million procedures performed annually in the USA. The goal of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is to achieve complete revascularization (CR) if at all possible. However, restenosis and stent thrombosis (ST) remain the Achilles heel of contemporary PCI with restenosis rates between 10 and 30% with bare metal stents to 5–15% after drug-eluting stents and ST rates of around 0.8 vs 1.2%, respectively. Routine angiography after revascularization seems theoretically attractive as this may allow intervention before clinical events occur. In this manuscript, we review the literature regarding routine angiography after PCI or CABG and its outcomes.

Recent Findings

According to the 2016 update from the American Heart Association (AHA), 15.5 million people above the age of 20 have coronary heart disease (CHD) in the USA. The prevalence of CHD is now almost similar in both men and women, and one American suffers from a myocardial infarction (MI) every 42 s. Recent data from randomized clinical trials and observational studies does not support the use of routine coronary angiography after revascularization in asymptomatic patients. There are some studies which show that routine angiography may have a role in left main or complex coronary interventions; however, these findings are exploratory and were not seen in randomized trials.

Summary

After reviewing the data on routine angiography after coronary revascularization, we came to the conclusion that current data does not support the use of routine angiography for asymptomatic patients. However, there is a lack of randomized controlled trial in this field with only one recent trial reporting negative outcomes.

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