Routine CT scanning after stenting for left main coronary artery disease was not more effective than symptom-based follow-up in reducing complications and further blockages, Italian researchers have found.
Dr. Ovidio De Filippo and colleagues from Hospital Citta Della Salute e della Scienza di Torino in Turin reported that the results from the PULSE study showed that routine six-month coronary CT (CCT) scan as follow-up did not show a reduction in the composite of all-cause death, myocardial infarction, unstable angina, or stent thrombosis over 18 months compared with symptom-based follow-up. The group presented the research in a Hot Line session on 31 August in Madrid at the European Society of Cardiology (ESC) Congress.
PULSE was an open-label, blinded-endpoint, randomized trial conducted at 15 sites in Europe and South America in which the participants were consecutive patients with critical stenosis who underwent percutaneous coronary intervention (PCI) for left main coronary artery disease. A total of 606 participants were randomized to either CCT-guided follow-up at six months (experimental arm) or standard symptom- and ischemia-guided management (control arm). The participants were then followed for an additional 12 months, for a total follow-up period of 18 months.
A primary-endpoint event occurred in 11.9% of patients in the CCT arm and 12.5% of patients in the control arm at 18 months (95% confidence interval [CI] 0.76 to 1.23; p = 0.8).
There was a reduced risk of spontaneous MI in the CCT arm compared with the control arm (0.9% vs. 4.9%; 95% CI 0.07 to 0.91; p = 0.004). However, while an increase in imaging-triggered target-lesion revascularization was observed in the CCT arm compared with the control arm (4.9% vs. 0.3%; 95% CI 1.7 to 33.7; p = 0.001), the incidence of clinically driven target-lesion revascularization was similar between the groups (5.3% vs. 7.2%; 95% CI 0.38 to 1.41; p = 0.32).
While CT scans as follow-up may not be universally more effective than symptom-based follow-up, principal investigator Professor Fabrizio D'Ascenzo, also from Hospital Citta Della Salute e della Scienza di Torino, said during the presentation that the findings suggest that the approach may have some utility.
“While universal CCT-based follow-up may not be useful, the marked reduction in spontaneous MI and identification of obstructive lesions requiring repeat PCI suggest this approach may be worth investigating further in selected patients with complex anatomies and over longer follow-up,” they stated.
