Exercise electrocardiography and myocardial scintigraphy in the serial evaluation of the results of percutaneous transluminal coronary angioplasty.

Abstract

SUMMARY The diagnostic value of exercise electrocardiography using 14 leads and thallium-201 scintigraphy were evaluated in 54 of 70 patients who underwent percutaneous transluminal coronary angioplasty (PTCA), both in the initial assessment and serial follow-up of patients after PTCA. Of the 45 patients who had successful PTCA, 36 had complete noninvasive studies performed before and 1 month after PTCA. Thirty-three of these 36 were asymptomatic 1 month after PTCA; the number of patients with an abnormal exercise ECG decreased from 20 to seven (p < 0.01) and with an abnormal thallium-201 scintigram from 21 to six (p < 0.001); the number of patients who had at least one of the two tests positive decreased from 26 to 10. The average treadmill time increased from 448 + 183 to 618 119 seconds (i < 0.001), and the average rate-pressure product increased from 19.81 ± 6.4 to 31.35 4.6 units x 10 (p < 0.001). Of the 10 patients with a positive test, two had a partial restenosis 50% but < 70% on the 6-month control angiogram; two had a residual stenosis ¢ 50% in a vessel that was not dilated and three had an abnormal scintigram before and 1 month after PTCA that subsequently became negative at 6 months. Six months after PTCA, a control angiogram was performed in 20 asymptomatic patients; 18 had an excellent PTCA result and two had a partial restenosis ¢ 50% but < 70%. The stress test results were normal in patients with a successful 6-month PTCA and abnormal in the two patients with a partial restenosis.Ten patients redeveloped angina within 3 months of PTCA; nine developed a restenosis ¢ 60% and one had a 90% left circumflex stenosis that could not be dilated or grafted. Six of the 10 patients had a normal exercise ECG and scintigram at 1 month that became abnormal when symptoms reappeared. The ratepressure product before PTCA and when angina symptoms recurred was similar (18.00 ± 2.20 vs 23.58 + units x 103) (NS).In conclusion, the use of clinical symptoms in conjunction with the physiologic data, ECG and myocardial scintigram acquired during exercise provide important short-term data on the angiographic evolution of PTCA results. The noninvasive tests may be useful in determining guidelines for repeat angiography in patients who have had PTCA.PERCUTANEOUS transluminal coronary angioplasty (PTCA) is a new technique that may be useful in the treatment of 5-10% of patients with coronary artery disease who are suitable candidates for coronary artery bypass grafting. 1-3However, the method is still considered an investigational procedure and many issues are not resolved.)7 Most reported series of PTCA are small and follow-up is short because the technique requires considerable expertise, is relatively new, and suitable patient recruitment is limited in most hemodynamic laboratories. The role of noninvasive diagnostic tests in the selection and serial follow-up of patients who are considered for PTCA is not well defined. In some reports, stress test results and radionuclide studies are not discussed, and in others the sequ...

A randomized trial of corticosteroids for the prevention of restenosis in 102 patients undergoing repeat coronary angioplasty

“…Estimates of restenosis rates range from 4-17% in asymptomatic patients, and from 50-76% in symptomatic patients [23]. The use of clinical symptoms in conjunction with objective evidence of ischemia with exercise testing more accurately predicts restenosis [47,48]. Thallium imaging, not performed at our institution during the study period, may be superior to symptoms or EKG changes in assessing restenosis post-PTCA [49].…”

Early detection of restenosis after successful percutaneous transluminal coronary angioplasty by exercise-redistribution thallium scintigraphy

“…(Am J Cardiol 1985;55:357-361) Restenosis after primary successful percutaneous transluminal coronary angioplasty (PTCA) occurs in 19 to 36% of patients within the first 6 months after the procedure. [1][2][3][4][5] This restenosis may manifest itself by changes in the patient's clinical status and may be detected by noninvasive diagnostic tests or by coronary angiography. Scholl2 and Hirze16 and their co-workers showed that an abnormal response on the exercise electrocardiogram (ECG) and a myocardial perfusion defect on the thallium scintigram is associated with angiographically documented restenosis of the dilated vessel or is a sign of the presence of additional disease.…”

The Predictive Value of Exercise QRS Duration Changes for Post‐PTCA Coronary Events

“…They found that ischemic ST-segment changes have a sensitivity of only 24% with a specificity of 88% in predicting restenosis. Several studies have examined the value of stress tests using exercisedipyridamole echocardiography or nuclear imaging after PTCA and found that the positive predictive value of stress thallium-201 myocardial perfusion scintigraphy for predicting restenosis is 53% to 82% with a negative predictive value of 75% to 95%, 13,22,23 whereas the positive predictive value of stress-induced wall motion abnormalities is 69% to 80% with a negative predictive value of 76%. 8,12,13 These tests are more expensive and less readily available than standard treadmill exercise testing.…”