Document Detail


Detection of coronary restenosis by exercise electrocardiography thallium-201 perfusion imaging and coronary angiography in asymptomatic patients after percutaneous transluminal coronary angioplasty.
MedLine Citation:
PMID:  10867089     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Noninvasive detection of restenosis in patients remaining asymptomatic after percutaneous transluminal coronary angioplasty (PTCA) remains a major clinical problem. The value of exercise electrocardiography (ECG) and exercise-redistribution thallium-201 single-photon emission computed tomography (SPECT) in detecting restenosis in such patients remains uncertain. Discordances between these tests and coronary angiography is a common situation. We studied 179 consecutive patients remaining asymptomatic after successful PTCA (208 vessels), who underwent 6 +/- 2 months of exercise ECG, SPECT, and coronary angiography. We sought to assess the diagnostic value of the noninvasive tests compared with coronary angiography, and identify the determinants of discordances between the tests. Restenosis (diameter stenosis >50%) was detected in 39% of patients and in 37% of vessels. The overall sensitivity, specificity, and accuracy for exercise ECG and SPECT in detecting restenosis in individual vessels were, respectively, 53% versus 63% (p = 0.06), 59% versus 77% (p = 0.0001), and 57% versus 72% (p = 0. 0001). On multivariate analysis, positive exercise ECG was associated with higher heart rate response (p = 0.02), incomplete revascularization (p = 0.004), and angiographic restenosis (p = 0. 03), whereas positive SPECT was associated with incomplete revascularization (p = 0.02), infarct-related artery PTCA (p = 0.01), and angiographic restenosis (p = 0.0001). Accuracies of the 2 tests were not significantly different in patients with incomplete revascularization or PTCA of an infarct-related vessel. Overall, SPECT is more accurate than exercise ECG in detecting asymptomatic restenosis. Nevertheless, incomplete revascularization and PTCA of an infarct-related artery could cause reversible perfusion defects regardless of restenosis, reducing the diagnostic value of SPECT in such patients.
Authors:
F Beygui; C Le Feuvre; C Maunoury; G Helft; T Antonietti; J P Metzger; A Vacheron
Related Documents :
25289709 - Combined swimming exercise and soybean intake reduces early atherosclerotic lesions and...
25440889 - Prognostic value of exercise capacity in patients with coronary artery disease: the fit...
12398909 - [11c]rn5: a new agent for the in vivo imaging of myocardial alpha1-adrenoceptors.
1531069 - Comparison of same-day protocols using technetium-99m-sestamibi myocardial imaging.
10146699 - Noninvasive prediction of restenosis after coronary angioplasty: a head to head compari...
7970439 - Pharmacological cardiac stress: when and how?
25448249 - Physical activity in primary vs. secondary prevention indication implantable cardiovert...
9727779 - Standardization of ambulatory peak flow monitoring: the importance of recent beta2-agon...
25300939 - Efficiency of pivot splints as jaw exercise apparatus in combination with stabilization...
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The American journal of cardiology     Volume:  86     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2000 Jul 
Date Detail:
Created Date:  2000-08-01     Completed Date:  2000-08-01     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  35-40     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology, Necker University Hospital, Paris, France. fbeygui@medscape.com
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Angioplasty, Transluminal, Percutaneous Coronary*
Coronary Angiography*
Coronary Disease / diagnosis*,  therapy
Diagnosis, Differential
Electrocardiography / methods*
Exercise Test
Female
Humans
Male
Middle Aged
Prognosis
Recurrence
Reproducibility of Results
Sensitivity and Specificity
Thallium Radioisotopes / diagnostic use
Tomography, Emission-Computed, Single-Photon*
Chemical
Reg. No./Substance:
0/Thallium Radioisotopes

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Angiographic and clinical characteristics associated with increased in-hospital mortality in elderly...
Next Document:  Safety and efficacy of percutaneous coronary interventions performed immediately after diagnostic ca...