Utility of various clinical, noninvasive, and invasive procedures for determining the causes of recurrence of myocardial ischemia or infarction > or = 1 year after percutaneous transluminal coronary angioplasty

Quality of life and coronary insufficiency in men with myocardial infarction and coronary reperfusion

Aim. To analyze the association between quality of life (QoL) and recurrent coronary insufficiency (CI) within 12 months after primary, uncomplicated myocardial infarction (MI) in working-age men, who underwent various types of coronary reperfusion. Material and methods. In total, 114 men aged <60 years — patients with primary, uncomplicated MI, were examined. CI recurrence was assessed clinically, based on typical angina (A) attacks. To diagnose silent CI, all patients underwent an exercise test (veloergometry) before the discharge, as well as 3, 6, and 12 months after MI. QoL was assessed with a Russian version of SF-36 questionnaire. Results. In CI-free men from the percutaneous coronary intervention (PCI) group, some QoL scales demonstrated a significant improvement at 3, 6, and 12 months. In the thrombolytic therapy (TLT) group, all QoL scales were significantly improved. The maximal QoL score was observed at 12 months in both groups. Patients with angina had decreased QoL, with the minimal score observed for role functioning domains (median score 0 and 12,5 in PCI and TLT groups, respectively) and emotional status (33 and 16,7, respectively). Conclusion. Regardless of the coronary reperfusion method in acute MI phase, CI-free patients demonstrated improved QoL, with the highest scores registered 12 months after MI. Angina recurrence affected physical and emotional role functioning in MI patients, restricting their daily life activities. However, recurrent CI did not affect social activity levels or the need for social interaction.

Detection of coronary restenosis by exercise electrocardiography thallium-201 perfusion imaging and coronary angiography in asymptomatic patients after percutaneous transluminal coronary angioplasty

Noninvasive detection of restenosis in patients remaining asymptomatic after percutaneous transluminal coronary angioplasty (PTCA) remains a major clinical problem. The value of exercise electrocardiography (ECG) and exercise-redistribution thallium-201 single-photon emission computed tomography (SPECT) in detecting restenosis in such patients remains uncertain. Discordances between these tests and coronary angiography is a common situation. We studied 179 consecutive patients remaining asymptomatic after successful PTCA (208 vessels), who underwent 6 +/- 2 months of exercise ECG, SPECT, and coronary angiography. We sought to assess the diagnostic value of the noninvasive tests compared with coronary angiography, and identify the determinants of discordances between the tests. Restenosis (diameter stenosis >50%) was detected in 39% of patients and in 37% of vessels. The overall sensitivity, specificity, and accuracy for exercise ECG and SPECT in detecting restenosis in individual vessels were, respectively, 53% versus 63% (p = 0.06), 59% versus 77% (p = 0.0001), and 57% versus 72% (p = 0. 0001). On multivariate analysis, positive exercise ECG was associated with higher heart rate response (p = 0.02), incomplete revascularization (p = 0.004), and angiographic restenosis (p = 0. 03), whereas positive SPECT was associated with incomplete revascularization (p = 0.02), infarct-related artery PTCA (p = 0.01), and angiographic restenosis (p = 0.0001). Accuracies of the 2 tests were not significantly different in patients with incomplete revascularization or PTCA of an infarct-related vessel. Overall, SPECT is more accurate than exercise ECG in detecting asymptomatic restenosis. Nevertheless, incomplete revascularization and PTCA of an infarct-related artery could cause reversible perfusion defects regardless of restenosis, reducing the diagnostic value of SPECT in such patients.