Which are the Best Follow-Up Strategies for Patients Who Undergo Percutaneous Coronary Interventions?

Alfredo R. Galassi; Salvatore Azzarelli; Salvatore Davide Tomasello; Giombattista Barrano; Miriam Cumbo; Corrado Tamburino

Abstract

Percutaneous coronary intervention has become a mainstay in the treatment of patients with coronary artery disease in recent years. However, restenosis, incomplete revascularization, and progression of disease continue to cause a need for a clinical functional assessment in order to reduce morbidity. Angiographic systematic follow-up should nowadays be considered a valuable approach only to monitor small groups of very high risk patients. Although coronary CT angiography seems able to non-invasively image the coronary artery lumen, but the presence of a stent could limit visualization of coronary morphology. Recurrence of symptoms itself has low sensitivity and specificity for detection of restenosis and myocardial ischemia. Exercise testing may provide useful information on symptoms and functional capacity of the patient; however, it is poorly diagnostic of restenosis and myocardial ischemia with a low level of sensitivity and specificity. Conversely, the significantly increased sensitivity and specificity obtained by stress nuclear, echocardiographic or magnetic resonance imaging provide great advantage for clinical assessment of these patients. Additional advantages of stress imaging are the ability to assess location and extent of myocardial ischemia regardless of symptoms as well as to evaluate patients who are unable to exercise or who have an uninterpretable electrocardiogram. Furthermore, the clear superiority of stress imaging with regard to specificity and predictive value for postrevascularization events makes this functional approach of paramount importance for assessing prognosis of such patients.

Keywords: Percutaneous coronary intervention, PTCA, coronary angiography, coronary CT angiography, myocardial scintigraphy, stress echocardiography