Detection of restenosis after elective percutaneous transluminal coronary angioplasty using the exercise treadmill test

James R. Bengtson, Daniel B. Mark, Michael B. Honan, David S. Rendall, Tomoaki Hinohara, Richard S. Stack, Mark A. Hlatky, Robert M. Califf, Kerry L. Lee, David B. Pryor

Research output: Contribution to journalArticle

98 Scopus citations

Abstract

To determine the value of a 6-month exercise treadmill test for detecting restenosis after elective percutaneous transluminal coronary angioplasty (PTCA), 303 consecutive patients with successful PTCA and without a recent myocardial infarction were studied. Among the 228 patients without interval cardiac events, early repeat revascularization or contraindications to treadmill testing, 209 (92%) underwent follow-up angiography, and 200 also had a follow-up treadmill test and formed the study population. Restenosis (≥75% luminal diameter stenosis) occurred in 50 patients (25%). Five variables were individually associated with a higher risk of restenosis: recurrent angina (p = 0.0002), exercise-induced angina (p = 0.0001), a positive treadmill test (p = 0.008), more exercise ST deviation (p = 0.04) and a lower maximum exercise heart rate (p = 0.05). However, only exercise-induced angina (p = 0.002), recurrent angina (p = 0.01) and a positive treadmill test (p = 0.04) were independent predictors of restenosis. Using these 3 variables, patient subsets could be identified with restenosis rates ranging from 11 to 83%. The exercise treadmill test added independent information to symptom status about the risk of restenosis after elective PTCA. Nevertheless, 20% of patients with restenosis had neither recurrent angina nor exercise-induced ischemia at follow-up. For more accurate detection of restenosis, the exercise treadmill test must be supplemented by a more definitive test.

Original languageEnglish (US)
Pages (from-to)28-34
Number of pages7
JournalThe American Journal of Cardiology
Volume65
Issue number1
DOIs
StatePublished - Jan 1 1990

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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