The use of functional tests and planned coronary angiography after percutaneous coronary revascularization in clinical practice.Results from the AFTER multicenter study

Mazzarotto, Pietro; Pristipino, Christian; Burzotta, Francesco; Serdoz, Roberto; Berni, Andrea; Sardella, Gennaro; Danesi, Alessandro; Di Sciascio, Germano; Zingales, Leone Dino; Loschiavo, Paolo; Sciahbasi, Alessandro; Gioffrè, Gaetano; Gemelli, Francesco

doi:10.1016/j.ijcard.2008.06.038

« Previous Next »International Journal of Cardiology
Volume 137, Issue 2 , Pages 151-157, October 2009

The use of functional tests and planned coronary angiography after percutaneous coronary revascularization in clinical practice.Results from the AFTER multicenter study

Pietro Mazzarotto
- Interventional Cardiology Unit, San Carlo Hospital, Rome, Italy
- Corresponding author. Unità operativa di cardiologia invasiva e interventistica endovascolare, Ospedale San Carlo, Via Aurelia 275, 00165 Roma, Italy. Tel.: +39 06 39706457; fax: +39 06 39706465.
Christian Pristipino
- Interventional Cardiology Unit, San Filippo Neri Hospital, Rome, Italy
Francesco Burzotta
- Institute of Cardiology, Catholic University, Rome, Italy
Roberto Serdoz
- Department of Cardiology, San Pietro Hospital, Rome, Italy
Andrea Berni
- Department of Cardiology, S. Andrea Hospital, “La Sapienza” University, Rome, Italy
Gennaro Sardella
- Department of Cardiology, Policlinico Umberto I, “La Sapienza” University, Rome, Italy
Alessandro Danesi
- Department of Cardiology, Santo Spirito Hospital, Rome, Italy
Germano Di Sciascio
- Department of Cardiology, Campus Biomedico University, Rome, Italy
Leone Dino Zingales
- Interventional Cardiology Unit, Belcolle Hospital, Viterbo, Italy
Paolo Loschiavo
- Interventional Cardiology Unit, Sandro Pertini Hospital, Rome, Italy
Alessandro Sciahbasi
- Department of Cardiology, Policlinico Casilino, Rome, Italy
Gaetano Gioffrè
- Department of Cardiology, Sant'Eugenio Hospital, Rome, Italy
Francesco Gemelli
- Interventional Cardiology Unit, San Carlo Hospital, Rome, Italy

Received 9 March 2008; received in revised form 17 June 2008; accepted 28 June 2008. published online 08 August 2008.

Abstract

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.

Keywords: Percutaneous transluminal coronary angioplasty, Coronary restenosis, Heart function tests, Follow-up studies