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

Research output: Contribution to journalArticle

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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
Pages (from-to)1585-1594
Number of pages10
JournalCirculation
Volume80
Issue number6
StatePublished - Dec 1 1989
Externally publishedYes

Fingerprint

Exercise Test
Angioplasty
Myocardial Infarction
Exercise
Emergencies
Bundle-Branch Block
Thrombolytic Therapy
Cardiac Catheterization
Catheterization
Coronary Disease
Angiography
Arteries
Logistic Models
Regression Analysis
Population

Keywords

  • angioplasty
  • exercise test
  • myocardial infarction
  • stenoses

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Honan, M. B., Bengtson, J. R., Pryor, D. B., Rendall, D. S., Stack, R. S., Hinohara, T., ... 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.

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

In: Circulation, Vol. 80, No. 6, 01.12.1989, p. 1585-1594.

Research output: Contribution to journalArticle

Honan, MB, Bengtson, JR, Pryor, DB, Rendall, DS, Stack, RS, Hinohara, T, Skelton, TN, Califf, RM, Hlatky, MA & Mark, DB 1989, 'Exercise treadmill testing is a poor predictor of anatomic restenosis after angioplasty for acute myocardial infarction', Circulation, vol. 80, no. 6, pp. 1585-1594.
Honan MB, Bengtson JR, Pryor DB, Rendall DS, Stack RS, Hinohara T et al. Exercise treadmill testing is a poor predictor of anatomic restenosis after angioplasty for acute myocardial infarction. Circulation. 1989 Dec 1;80(6):1585-1594.
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. / Exercise treadmill testing is a poor predictor of anatomic restenosis after angioplasty for acute myocardial infarction. In: Circulation. 1989 ; Vol. 80, No. 6. pp. 1585-1594.
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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.",
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N2 - 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.

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