Results of ReACT Trial presented
A randomized evaluation of routine follow-up coronary angiography after percutaneous coronary intervention (PCI) found that there was no long-term clinical benefit compared to clinical follow-up alone among unselected patients following PCI.
Findings from the ReACT trial were reported today at the 28th annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium. Sponsored by the Cardiovascular Research Foundation (CRF), TCT is the world's premier educational meeting specializing in interventional cardiovascular medicine. The study was also simultaneously published in JACC: Cardiovascular Interventions.
In this prospective, multicenter, open label, randomized study, patients who underwent successful PCI without planned staged PCI were randomly assigned to the routine angiographic follow-up (AF) group, in which they received coronary angiography at 8-12 months after PCI, or the clinical follow-up (CF) group. The primary endpoint was defined as a composite of death, myocardial infarction, stroke, emergency hospitalization for acute coronary syndrome, or hospitalization for congestive heart failure during a minimum of 1.5 years follow-up.
Between May 2010 and July 2014, a total of 700 patients were enrolled in the trial at 22 centers in Japan and were randomly assigned to the AF group (N=349) or the CF group (N=351). Although there was a greater incidence of repeat revascularization at one year among patients in the AF group, during the median 4.6 (inter-quartile range: 3.1-5.2) years follow-up, the cumulative 5-year incidence of the primary endpoint was no different between groups (22.4% in the AF group vs. 24.7% in the CF group; hazard ratio: 0.94, 95% confidence interval: 0.67-1.31, P=0.70). There were also no significant differences between the AF and CF groups in terms of any other clinical endpoints. Coronary revascularization within the first year was more frequently performed in the AF group than in CF group (12.8% vs. 3.8%, log-rank P<0.001), although the difference between the two groups attenuated over time with similar cumulative five-year incidence (19.6% vs. 18.1%, log-rank P=0.92).
"In this study, routine follow-up coronary angiography after PCI, as compared with clinical follow-up alone, did not bring any significant clinical benefit," said lead investigator Hiroki Shiomi, MD from Kyoto University Hospital in Kyoto, Japan.
"Thus, routine follow-up coronary angiography after PCI cannot be recommended as a clinical strategy. However, the present study was underpowered to detect modest benefits or harm of routine FUCAG, and larger-scale trials, especially in high-risk patients, are warranted to definitively address this issue."
The ReACT trial was funded by the Research Institute for Production Development. Dr. Shiomi reported grant/research support from The Research Institute for Production Development.
The results of the ReACT trial will be presented on Tuesday, November 1 at 1:00 PM ET in the Main Arena (Level 3, Ballroom) of the Walter E. Washington Convention Center.
