Assessment of “silent” restenosis and long-term follow-up after successful angioplasty in single vessel coronary artery disease: The value of quantitative exercise electrocardiography and quantitative coronary angiography

Abstract

Exercise electrocardiographic (ECG) testing during follow-up after coronary angioplasty is widely applied to evaluate the efficacy of angioplasty, even in asymptomatic patients. One hundred forty-one asymptomatic patients without previous myocardial infarction underwent quantitative exercise ECG testing and quantitative coronary angiography 1 to 6 months after successful angioplasty in single vessel coronary artery disease to 1) determine the value of exercise ECG testing to detect "silent" restenosis, and 2) assess the long-term prognostic value of exercise ECG testing and coronary angiography. The prevalence of restenosis (defined as greater than or equal to 50% luminal narrowing at the dilation site) was 12% in this selected study group. Of 26 patients with an abnormal exercise ECG (ST segment depression greater than or equal to 0.1 mV), only 4 (15%) showed recurrence of stenosis. Sensitivity and specificity for detection of restenosis were 24% and 82%, respectively. One hundred thirty-four patients (95%) were followed up 1 to 64 months (mean 35) after exercise ECG testing and coronary angiography. Thirty-two patients (24%) experienced a cardiac event: in 25 patients (78%) the initial event was recurrent angina pectoris (New York Heart Association class III or IV) and in 7 patients (22%) it was myocardial infarction, although cardiac death did not occur. The mean interval between exercise ECG testing and the initial cardiac events was 14 months (range 1 to 55), whereas 47% of the initial events took place less than or equal to 6 months after exercise ECG testing.(ABSTRACT TRUNCATED AT 250 WORDS)

Preprocedural red blood cell distribution width predicts bare metal stent restenosis

“…We followed up the patients with BMS 9.8±9.3 months. A pooled analysis of 15 treadmill studies involving 2250 patients with angiographic follow-up showed a 50% positive predictive value and a 76% negative predictive value for the exercise treadmill test [37][38][39][40][41]. Therefore, the higher stent restenosis rate may be related to the longer follow-up period.…”

Detection of Restenosis following Percutaneous Coronary Angioplasty in Single-Vessel Coronary Artery Disease: The Value of Clinical Assessment and Exercise Tolerance Testing

“…The sensitivity of exercise stress tests increases with the extent of coro nary artery disease, which implies a low sensi tivity in those patients with only single-vessel disease [2,5,6], Although some investigators [7] report a good correlation between symp toms and angiographic restenosis, others [8] (including ourselves) failed to do so.…”

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

“…According to our results, incorporation of right-sided chest leads improved the reliability of the technique (Se, Sp, Ppv, Npv, and Ac up to 79%, 97%, 69%, 98%, and 95% respectively) in levels similar or even better to them from SPECT and stress echocardiography. 10,11,18,19 The improvement in the ability of exercise testing in detecting coronary artery disease and restenosis in RCA and LCX with the use of right-sided chest leads seems reasonable since V 3 R through V 5 R leads (which are located symmetrically to V 3 R through V 5 R in the right hemithorax) ''view'' the inferolateral surface of the heart which is dominantly supplied from RCA and LCX.…”