LAUSR

Routine 6-month angiographic follow-up was common practice back in the 90’s due to relatively high rates of significant restenosis. Back then, the rate of repeated target vessel revascularization (TVR) could be as high as 30–40% in specific patient subsets, such as diabetics, long lesions or small vessels [1]. Invasive imaging is also a necessary part of the comprehensive evaluation of new devices and coronary intervention strategies, which have clearly helped the scientific community to bring down target vessel failure rates to one-digit figures. However, the systematic performance of repeated catheterization in asymptomatic, ischemia-free patients, undoubtedly leads to more interventions, the so called “oculostenotic reflex”, without clear reduction in myocardial infarction or cardiovascular mortality [2, 3]. But, is this also true for patients with left main or last remaining vessel percutaneous coronary intervention (PCI)? In this issue of “Cardiology Journal”, Aurigemma et al. [4] present interesting results from a retrospective study evaluating the impact of routine angiographic follow-up after successful PCI of unprotected left main stenoses. Approximately 90% of the 190 patients were treated with a 1-stent technique and index procedures were performed with intravascular imaging in roughly 1 out of 4 cases. Despite interventionalists’ recommendations to perform routine 6to 9-month catheterizations in all patients, it was not done in 48% of those eligible cases due, most likely, to patient and physician preference. As expected, study groups had some important differences at baseline: patients in the clinical follow-up group tended to be older (although not a statistically significant difference), with also a trend to a higher rate of renal failure and with more prior myocardial infarctions. Patients in the angiographic follow-up group were more commonly treated with a 2-stent technique, although rates of final kissing-balloon were rather similar (65%). The main finding of this study is that routine angiographic group had 3× higher TVR rates, but more importantly cardiac mortality were significantly lower at a mean follow-up of 35 months. Different groups have tried to analyze the impact of systematic angiographic follow-up after sucessful left main PCI [5–7]. In contrast to the study of Aurigemma et al. [4], other Italian investigators, looking into a similar retrospective database of 198 patients with left-main treated between 2002 and 2007, found that routine angiographic followup did not reduce myocardial infarction or cardiac death [5]. In a larger multicenter registry enrolling 1267 patients with left main treated with secondgeneration drug-eluting stent (DES), 440 patients