A new predictor of restenosis after successful percutaneous transluminal coronary angioplasty in patients with multivessel coronary artery disease

With the goal of improving prediction of restenosis after percutaneous transluminal coronary angioplasty (PTCA) for multivessel coronary artery disease (CAD), we evaluated the usefulness of serial exercise treadmill tests. We previously reported that an increase in the Delta ST/Delta heart rate (HR) index at follow-up over the value obtained several days after PTCA was useful for detecting restenosis following PTCA for 1-vessel CAD. In that report, comparison of the Delta ST/Delta HR index was made based on measurements from the lead disclosing the greatest ST displacement before PTCA. This method was not applicable to patients with multivessel CAD. Seventy-eight patients with multivessel CAD before and several days after PTCA and lust before follow-up performed exercise treadmill tests. Simple HR-adiusted indexes of ST-segment depression during exercise (Delta ST/Delta HR index) and the sum of the Delta ST/Delta HR index in leads II, III, aVF, V-4, V-5, and V-6 (Sigma Delta ST/Delta HR index) were determined. We compared the predictive power of an increase in Sigma Delta ST/Delta HR index at follow-up with that of a positive exercise treadmill test and a positive thallium scintigram for restenosis. At follow-up, 37 of the 78 patients showed restenosis. The Sigma Delta ST/Delta HR index had increased in 30 of these 37 patients (81%), and in 12 of the 41 patients (29%) without restenosis. An increase in Sigma Delta ST/Delta HR index had a significantly higher sensitivity than the other methods and a significantly higher specificity than a positive exercise treadmill test. (C) 1997 by Excerpta Medica, Inc.