The ReACT Study: Is Angiographic Follow-Up Necessary?

The purpose of this study was to assess the long-term clinical impact of routine angiographic follow-up after coronary angioplasty.

Routine angiographic follow-up has been criticized by both clinical and interventional cardiologists for increasing the rate of coronary revascularization due to the “oculostenotic reflex.” This caused a shift in the paradigm for clinical studies, and trials began to use revascularization justified by ischemia or clinical evidence as an endpoint.

Such was the case for randomized controlled trials, but the actual existence of the “oculostenotic reflex” in daily clinical practice was never proved.

In this prospective, multicenter, open-label trial in Japan, patients who underwent successful coronary angioplasty were randomly assigned to routine angiographic follow-up (control angiography between 8 and 12 months after angioplasty) vs. clinical follow-up alone.

The primary endpoint was a composite of death, infarction, stroke, emergency hospitalization for acute coronary syndrome, or hospitalization for heart failure over a minimum of 1.5 years of follow-up.

Between May 2010 and July 2014, 700 patients were enrolled in 22 participating centers and were randomly assigned to the angiographic follow-up group (n = 349) or the clinical follow-up group (n = 351).

During a mean follow-up of 4.6 years, the cumulative 5-year incidence of the primary endpoint was 22.4% for the routine angiography group compared with 24.7% for the clinical follow-up alone group (p = 0.70).

Any coronary revascularization within the first year was more frequently performed in the angiographic follow-up group (12.8% vs. 3.8%; p <0.001), thus confirming the existence of the famous oculostenotic reflex in daily clinical practice as well. However, this difference disappeared at 5 years, during which the revascularization rate was similar between both groups (19.6% vs. 18.1%; p = 0.92).

Conclusion

Angiographic follow-up after successful coronary angioplasty presents no clinical benefit and causes an increase in the rate of revascularization within the first year.

Original title: The ReACT Trial. Randomized Evaluation of Routine Follow-up. Coronary Angiography After Percutaneous Coronary Intervention Trial.

Reference: Hiroki Shiomi et al. JACC Cardiovasc Interv. 2017 Jan 23;10(2):109-117.

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