Does routine angiographic control make sense after percutaneous coronary intervention?

Background and Purpose: Is it possible to avoid routine coronary angiography after previous coronary intervention, if angiography is done only on patients with pathologic or questionable results in noninvasive diagnostic tests (recent medical history; exercise electrocardiography)? Patients and Methods: During the period from January 1996 until December 2000, all patients who underwent interventional treatment of coronary vessels (n = 509) were routinely reexamined by coronary angiography within 3-6 months. Out of the total group as well as out of the patients with normal exercise electrocardiography, all patients with significant restenosis or new stenosis were identified. Patients with pathologic exercise electrocardiography and patients who could not tolerate exercise electrocardiography were marked. Results: Out of 509 control angiograms, 105 restenoses, 15 new stenoses and four patients with both a restenosis plus additional new stenosis were found. 92% of these patients underwent a new coronary intervention. Results of exercise electrocardiography in 477 patients were evaluated. In 276 patients (58%), exercise electrocardiography could not at all or not satisfactorily be carried out. In 97 patients (20%), exercise electrocardiography proved pathologic. In a total of only 201 patients, valid results of exercise electrocardiography could be utilized. Exercise electrocardiography, in these cases, had a sensitivity of 68% and a specificity of 60%. 18% of 104 patients with normal exercise electrocardiography and 24% of all patients had a significant coronary stenosis. Conclusion: In 21% of patients with coronary intervention, a recurrent stenosis was present in the area of previous treatment. These results equal those in the literature. In almost 60% of patients, a usable exercise electrocardiography could not be carried out. In 20%, this test showed pathologic findings. If, in addition to exercise electrocardiography, no other noninvasive tests were used, an indication for angiographic control was found in 80% of patients. False-negative exercise electrocardiography results were seen in 18%. Looking at medical history and exercise electrocardiography results as indication for angiographic control for routine coronary angiography, a saving of almost 22% of coronary angiograms; could be realized. On the other hand, 16% of all patients with recurrent or new stenoses would be missed. These data show the clinical reality in a major medical center without a special department of cardiology. They match the data in the literature.