Utility of various clinical, noninvasive, and invasive procedures for determining the causes of recurrence of myocardial ischemia or infarction ≥1 year after percutaneous transluminal coronary angioplasty
| Autor: | Joseph E. Parrillo, Lloyd W. Klein, James E. Calvin, Eugene Uretz, Munawar Ali Qurashi, Surendra B. Avula |
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| Rok vydání: | 1995 |
| Předmět: |
Male
medicine.medical_specialty Myocardial Infarction Myocardial Ischemia Constriction Pathologic Coronary Angiography Sensitivity and Specificity Angina Electrocardiography Restenosis Predictive Value of Tests Recurrence Internal medicine medicine Humans cardiovascular diseases Myocardial infarction Angioplasty Balloon Coronary Aged Analysis of Variance Chi-Square Distribution medicine.diagnostic_test business.industry Unstable angina Canadian Cardiovascular Society Middle Aged medicine.disease Coronary arteries Thallium Radioisotopes Stenosis medicine.anatomical_structure Angiography Exercise Test Cardiology Female Radiology Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | The American Journal of Cardiology. 75:1003-1006 |
| ISSN: | 0002-9149 |
| DOI: | 10.1016/s0002-9149(99)80712-7 |
| Popis: | In patients with recurrent symptoms ≥1 year after successful percutaneous transluminal coronary angioplasty (PTCA), the decision of whether to proceed directly with coronary angiography or to evaluate the patient noninvasively can be difficult. To determine which demographic, historical, clinical, and laboratory factors are useful in helping to make this decision, 76 consecutive patients who presented >1 year (768 ± 309 days) after successful PTCA with resolution of symptoms were studied. The initial PTCA successfully treated all stenoses (except chronically occluded vessels) in all major vessels and segments. The patient group was predominantly men (68%), with a mean age of 64 ± 10 years. A prior myocardial infarction was present in 39 patients (51%), and there was a mean or 2.8 risk factors per patient. In patients who presented with recurrent symptoms, the Canadian Cardiovascular Society functional class was 2.0 ± 0.9; 2 patients presented with acute infarctions, 57 were admitted to the hospital with unstable angina, and 17 had stable angina. New electrocardiographic changes at rest were found in 19 of 74 patients (26%) with recurrent angina. A thallium stress test was performed in 40 patients (53%), with a sensitivity of 77% and a specificity of 36% for the presence of a significant stenosis. No nonangiographic variable was predictive of angiographic findings. At angiography, the number of coronary arteries with ≥50% diameter narrowing was 1.4 ± 1.0. Forty-two patients had stenosis at a new site, 7 had restenosis, and 27 had no new stenoses. Thus, differentiation between restenosis, disease progression, and quiescence is only accomplished by coronary angiography, since neither clinical nor noninvasive parameters are predictive of changes in coronary anatomy. |
| Databáze: | OpenAIRE |
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