Abstract 12468: Follow-up Coronary Angiography at Chronic Phase is Beneficial in Patients With Acute Myocardial Infarction
Backgrounds: Follow-up coronary angiography (FCA) after acute myocardial infarction (AMI) may be useful in detecting asymptomatic coronary artery lesions. It is unknown whether routine FCA is beneficial in patients with AMI.
Methods and Results: Five hundred and eighty-one patients with AMI undergoing percutaneous coronary intervention (PCI) at the acute phase and who survived for >one year after AMI were included in this study. Routine FCA was performed in 469 (81%) within one year after AMI, and not in the other 112 (19%). We examined the subsequent mortality after one year between FCA and non-FCA group (mean follow-up period, 3.8 years). Severity of AMI expressed by the anterior AMI, left ventricular ejection fraction, number of vessels with significant stenotic lesion, and maximal creatine kinase level were similar between the two groups. There was no procedure-related complication in FCA group. Patients in non-FCA group were significantly older than those in FCA (72±13 vs. 64±12; p≤0.001). Estimated glomerular filtration rate (eGFR (ml/min/1.73m2)) level was significantly lower in non-FCA group than in FCA (65±27 vs. 76±43; p≤0.05). In 153 of FCA patients (33%), PCI was done against new or restenotic lesion after FCA. Kaplan-Meier analysis showed that all-cause mortality after one year was significantly lower in FCA group than in non-FCA (4.9% vs. 19.8%; p≤0.001 by Log-rank test). Cardiac mortality after one year was also significantly lower in FCA group than in non-FCA (0.9% vs. 4.5%; p=0.004 by Log-rank test). AMI recurred in 2.1% in FCA group and in 3.6% in non-FCA after one year (p=0.499 by Log-rank test). Multivariate analysis adjusted for age and eGFR revealed that FCA was associated with reduced all-cause mortality after one year (HR, 0.371; 95%CI, 0.197-0.703; p=0.003). However, FCA was not associated necessarily reduced with cardiac mortality after one year (HR, 0.280; 95%CI, 0.064-1.188; p=0.083).
Conclusions: FCA at chronic phase is independently associated with better long-term prognosis and therefore seems to be beneficial in patients with AMI. Its cost effectiveness needs to be determined.
- © 2013 by American Heart Association, Inc.