Recognition of restenosis: can patients be defined in whom the exercise-ECG result makes angiographic restudy unnecessary?

ABSTRACT

The value of exercise ECG in predicting the occurrence of restenosis after successful transluminal coronary angioplasty (PTCA) was investigated in 398 patients with exercise tests of comparable workload before, immediately after and within 6 months after PTCA. In patients with normalized exercise ECG (n = 166) restenosis was observed in 16.3% and indication for repeat PTCA was present in 6.6%. RePTCA was recommended in only 3.2% of patients if the exercise test was still normal at restudy and if the patients were free of anginal symptoms. In patients with a renewed ST-segment depression (n = 77) the rate of restenosis was 67.5% and the indication for rePTCA was present in 52%. In patients without changes in the exercise tests before and after PTCA and at restudy (n = 155) restenosis was seen in 25.8% and rePTCA was recommended in 14.2%. It is concluded that from the clinical point of view, in patients with improved exercise ECG at restudy, especially if they are free of angina, there is no need for a re-angiogram because indications for rePTCA are very rare.