Detection of angiographic coronary restenosis after percutaneous transluminal coronary angioplasty (PTCA): Usefulness of angina combined with rest electrocardiogram

Purpose. To evaluate the value of recurrent anginal symptoms combined with seriation of conventional EKG in detecting coronary restenosis (renarrowing greater than or equal to 50% at the site dilated) after PTCA. Two hundred and seventy patients (204 men, mean age 53.1 +/- 9.4 years) with angina who submitted to successful PTCA of single-vessel coronary disease were follow ed and restudied angiographically 5.2 +/- 1.6 months after the procedure. A t any moment from PTCA to follow-up: 1) typical angina pectoris was classif ied as either absent or present; 2) a 12-lead EKG was classified as improve d, unchanged or worsened in comparison with the EKG either before or early after PTCA on the basis of ST-T alterations; 3) all patients underwent coro nariography and were then classified as either having or lacking restenosis . The sensitivity and predictive positive value of recurrent angina, worsen ed EKG, or both, in detecting restenosis were respectively: 74.6% and 68.6% , 44.3% and 85.3%, and 55.9 and 91.7%. The specificity and predictive negat ive value of no recurrence of angina, improved EKG, or both, in detecting t he absence of restenosis were respectively: 85.8% and 89.1%; 69.6% and 91.0 %; and 75.6% and 93.9%. Conclusion. In single-vessel coronary disease, the detection of coronary re stenosis after PTCA based on behavior of the symptoms plus rest EKG seriati on shows acceptable degrees of sensitivity, specificity and mainly of predi ctive values when comparison with respective historical values of the ergom etric test is considered.