Guimarães J, Menéres M J, Pitra A, Araújo D, Rodrigues A, da Silva P F, Braga J P, Gonçalves M, Teixeira M, Simões L, Gama V
Centro Hospitalar de Vila Nova de Gaia.
Rev Port Cardiol. 2000 Feb;19(2):227-31.
We analyse the value of the clinical data, isolated or associated with the stress EKG (SEKG) variables, in the detection of angiographic restenosis (AR: lesion > 50%), in a group of patients (pts) submitted to coronary angioplasty (PTCA) with stenting.
105 patients were followed prospectively (male: 87%; age: 56 +/- 10); clinical evaluation was performed in the 1st, 3rd and 6th month, SEKG in the 4th month and recatheterization for angiographic control in the 6th month. The vascular risk factors, cause of admission, medication at discharge, angiographic and procedure characteristics were analysed.
The most frequent vascular risk factors were hypertension (42%), smoking (64%), and dyslipidemia (52%); 30% had previous ischemic heart disease. The indication for PTCA was myocardial infarction (direct PTCA or residual ischemia) in 42% and angina in 59%. All patients were discharged with AAS and ticlopidine, 38% with beta-blockers, 59% with calcium channel blockers and 92% with nitrates. Thirty-eight percent had multivessel disease. They were submitted to dilatation with the implantation of 128 stents in 199 vessels. An intraaortic balloon pump was used in 13% and Abciximab in 47% of the procedures. In the recatheterization for angiographic control in the sixth month, 30 patients had angiographic restenosis (AR rate = 25.2%). In the clinical evaluation, 22 patients (20.9%) had angina, and 14 of them had angiographic restenosis (clinical restenosis rate = 13.3%). In the 16 asymptomatic patients with AR, 5 had positive SEKG.
The presence of angina in a group of patients submitted to coronary angioplasty with stenting has a low sensitivity (54%), a good specificity (88%), a positive predictive value of 64% and negative of 83% in the detection of angiographic restenosis. The association with clinical data improves sensitivity (83%), with a decrease in specificity (61%).
