Follow-up tests and outcomes for patients undergoing percutaneous coronary intervention: analysis of a Japanese administrative database
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Follow-up tests after percutaneous coronary intervention (PCI) are considered inappropriate for asymptomatic patients. Despite this perception, many cardiologists conduct follow-up tests as routine practice. The objective of this study was to investigate the survival benefits of follow-up testing after PCI in a real-world setting in Japan. A nationwide Japanese administrative database was used to identify unselected patients who underwent PCI with stent implantation between January 2010 and December 2013. We used time-dependent Cox proportional hazards models to evaluate the association between follow-up testing and outcomes. The primary outcome was the composite of all-cause death and acute myocardial infarction (AMI). Among a total of 21,409 patients, 15,095 (70.5%) completed follow-up testing, of whom 9814 (45.0%) underwent coronary angiography. During a median of 2.7 years of observation, the primary outcome occurred less frequently for patients who underwent follow-up testing (1.21 vs. 4.51% per year; adjusted hazard ratio, 0.59; 95% CI 0.52–0.67; p < 0.001). Individual rates of all-cause death and AMI were also lower for the patients who underwent follow-up testing. Follow-up testing was associated with a lower risk of all-cause death and/or AMI. However, because of the unexpectedly large effect and many limitations of the administrative data, our findings should be further investigated to assess the net benefit of follow-up tests. In addition, we do not intend to encourage routine follow-up tests for patients without clear clinical indications. Follow-up tests should be conducted in accordance with clinical indications.
KeywordsCoronary artery disease Stress test Coronary angiography Percutaneous coronary intervention
We thank Mr. Masaki Nakamura, Medical Data Vision Co., Ltd., for generous provision of the claims data.
Compliance with ethical standards
Conflicts of interest
Dr. Kawakami received honoraria from Astellas, Eisai, Abbie, Takeda Pharmaceutical Company Limited, Novartis KK, Santen, Bayer Yakuhin, Sanofi K.K., Kyowa Hakko Kirin, and Otsuka Pharmaceutical and consult fees from Olympus and Kaken Pharmaceutical. There are no patents, products in development, or marketed products to declare that are relevant to those companies. Other authors: None declared.
Research involving human participants and/or animals
The present study was approved by the Ethics Committee of Kyoto University Graduate School of Medicine (R0705).
Because all data were anonymized, the requirement for informed consent was waived.
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