Impact Of Routine Angiographic Follow-up on Long-term Clinical Outcomes in Diabetic Patients Underwent Successful Percutaneous Coronary Intervention

초록

BACKGROUND Routine angiographic follow up after drug-eluting stent (DES) implantation does not generally improve clinical outcomes and may increase revascularization rates. High-risk patients such as those with diabetes mellitus (DM) may require closer monitoring. We evaluated the impact of routine angiographic follow up (RAF) on long-term clinical outcomes in DM patients who treated with DES. METHODS This study included 2,441 patients with DM treated with DES from January 2004 to June 2021. Patients unexpected death, recurrent myocardial infarction, or revascularization before 6 months post-percutaneous coronary intervention (PCI) were excluded. RAF is defined as scheduled angiography at the physician’s discretion. The patients were assigned to two groups according to RAF; 1) The clinical follow up (CF) group (n = 1,300) and 2) The RAF group (n = 1,041). We compared 5-year major clinical outcomes between groups, using propensity score matching (PSM) to adjust for baseline confounders. RESULTS After PSM, a total of 731 pairs were yielded. Baseline characteristics were balanced between the CF and the RAF group. The RAF group had a significantly higher rate of revascularization on target lesion (HR: 1.95, 95% CI: 1.22 - 3.12) and target vessel. (HR: 1.79, 95% CI: 1.20 - 2.67) but lower trend of total death (HR 0.60, 95% CI:0.36-1.00, P=0.051) up to 5-year. Landmark analysis after 1 year, the RAF group showed no difference in repeat PCI but lower trend of total death (HR 0.57, 95%CI:0.31-1.04, P=0.068) and lower major adverse cardiac events (MACE, HR: 0.69, 95% CI: 0.49 - 0.99) compared with the CF group. CONCLUSION In our study, RAF in diabetic patients treated with DES implantation was closely associated with higher revascularization rate as compared to CF. However, RAF may be associated with improved survival and long-term composite clinical outcomes.