Exercise treadmill testing is a poor predictor of anatomic restenosis after angioplasty for acute myocardial infarction

M. B. Honan, J. R. Bengtson, D. B. Pryor, D. S. Rendall, R. S. Stack, T. Hinohara, T. N. Skelton, R. M. Califf, M. A. Hlatky, D. B. Mark

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46 Scopus citations

Abstract

This study evaluated whether an exercise treadmill test could predict restenosis in 289 patients 6 months after a successful emergency angioplasty of the infarct-related artery for acute myocardial infarction. After excluding those with interim interventions (64), medical events (36), or medical contraindications to follow-up testing (25), both a treadmill test and a cardiac catheterization were completed in 144 patients, 88% of those eligible for assessment. Four patients with left bundle branch block or pacemaker rhythm at the time of treadmill testing were also excluded from analysis. Of six follow-up clinical and treadmill variables examined by multivariate logistic regression analysis, only exercise ST deviation was independently correlated with restenosis at follow-up (χ2 = 5, p = 0.02). The clinical diagnosis of angina at follow-up, although marginally related to restenosis when considered by itself (p = 0.04), did not add significant information once ST deviation was known. The sensitivity of ST deviation of 0.10 mV or greater for detecting restenosis was only 24% (13 of 55 patients), and the specificity was 88% (75 of 85 patients). The sensitivity of exercise-induced ST deviation for detection of restenosis was not affected by extent or severity of wall motion abnormalities at follow-up, by the timing of thrombolytic therapy or of angioplasty, or by the presence of collateral blood flow at the time of acute angiography. A second multivariable analysis evaluating the association of the same variables with number of vessels with significant coronary disease at the 6-month catheterization found an association with both exercise ST deviation (p = 0.003) and exercise duration (p = 0.04). Angina symptoms and exercise treadmill test results in this population had limited value for predicting anatomic restenosis 6 months after emergency angioplasty for acute myocardial infarction.

Original languageEnglish (US)
Pages (from-to)1585-1594
Number of pages10
JournalCirculation
Volume80
Issue number6
DOIs
StatePublished - Jan 1 1989

Keywords

  • angioplasty
  • exercise test
  • myocardial infarction
  • stenoses

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

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    Honan, M. B., Bengtson, J. R., Pryor, D. B., Rendall, D. S., Stack, R. S., Hinohara, T., Skelton, T. N., Califf, R. M., Hlatky, M. A., & Mark, D. B. (1989). Exercise treadmill testing is a poor predictor of anatomic restenosis after angioplasty for acute myocardial infarction. Circulation, 80(6), 1585-1594. https://doi.org/10.1161/01.CIR.80.6.1585