Exercise stress testing before and after successful multivessel percutaneous transluminal coronary angioplasty

Abstract

Controversy exists regarding the diagnostic accuracy, optimal technique, and timing of exercise testing after percutaneous coronary intervention. The objectives of the present study were to analyze variables and the power of exercise testing to predict restenosis or a new lesion, 6 months after the procedure. Eight-four coronary multiartery diseased patients with preserved ventricular function were studied (66 males, mean age of all patients: 59 ± 10 years). All underwent coronary angiography and exercise testing with the Bruce protocol, before and 6 months after percutaneous coronary intervention. The following parameters were measured: heart rate, blood pressure, rate-pressure product (heart rate x systolic blood pressure), presence of angina, maximal ST-segment depression, and exercise duration. On average, 2.33 lesions/patient were treated and restenosis or progression of disease occurred in 46 (55%) patients. Significant increases in systolic blood pressure (P = 0.022), rate-pressure product (P = 0.045) and exercise duration (P = 0.003) were detected after the procedure. Twenty-seven (32%) patients presented angina during the exercise test before the procedure and 16 (19%) after the procedure. The exercise test for the detection of restenosis or new lesion presented 61% sensitivity, 63% specificity, 62% accuracy, and 67 and 57% positive and negative predictive values, respectively. In patients without restenosis, the exercise duration after percutaneous coronary intervention was significantly longer (460 ± 154 vs 381 ± 145 s, P = 0.008). Only the exercise duration permitted us to identify patients with and without restenosis or a new lesion.

Right‐sided Chest Leads in Exercise Testing for Detection of Coronary Restenosis

“…In recent studies, Isaaz et al 19 evaluated stress SPECT imaging performed routinely at 6 months in asymptomatic patients for predicting angiographic restenosis after successful direct percutaneous intervention for acute STelevation myocardial infarction and reported Se, Sp, Ppv, Npv, and Ac up to 73%, 62%, 29%, 92%, and 64% respectively while Chalela et al 20 evaluated exercise stress testing before and after successful multivessel percutaneous transluminal coronary angioplasty and found Se, Sp, and Ac up to 61%, 63%, and 62% respectively. No previous data are available concerning the ability of a 15-lead (standard 12-leads and 3 right-sided chest leads) ET to detect coronary restenosis.…”

The Role of Exercise Test After Percutaneous Coronary Intervention

“…Follow-up period results were included -data of coronary angiography finding (restenosis and/or new stenosis of coronary artery(-ies)), acute coronary events (recurrent hospitalization, myocardial infarction, coronary artery bypass grafting, recurrent coronary angiography and/ or PCI). The result of revascularization was defined, basing on the data of coronary angiography finding: -successful PCI defined as a dilatation of coronary artery stenosis with complete revascularization, if residual stenosis of coronary artery(-ies) does not exceed 50 % (Wenaweser et al, 2008); -incomplete revascularization defined as a residual stenosis (narrowing of the lumen of artery after performed PCI) greater than or equal with 50 % in any coronary artery (Chalela et al, 2006). Restenosis of coronary artery at the follow-up period was defined as a narrowing of coronary artery(-ies) lumen greater than or equal with 50 % and progression of coronary artery disease, if new stenosis of coronary artery was diagnosed (Chalela et al, 2006).…”

Valor prognóstico de provas funcionais na evolução tardia de pacientes com infarto agudo do miocárdio tratados com angioplastia coronária transluminal percutânea primária com implante de stent

“…Embora não tenha apresentado associação significativa com reestenose, o número de METS alcançado foi satisfatório, indica bom prognóstico, resultado que está de acordo com os dados da literatura (Myers et al, 2001, Dutcher et al, 2007 (Chalela et al, 2006).…”