However, the DTS did not independently predict clinical events.Īlthough the statistical power of the study was limited by the small number of clinical events (particularly MI and death), the results of this study support the ACC/AHA guidelines that exercise treadmill testing should not be used routinely after PCI. In a multivariate logistic regression model, coronary stenting during PCI and a >/= 85% MPHR achieved were found to be inversely associated with clinical events. At 9 months, the cardiac procedure rate was 18.8% in those with a positive test, 13.0% in those with an indeterminate test, and 6.3% in those with a negative test (p = 0.07 positive vs. The sensitivity of early ETT for predicting clinical events was 41.2%, the specificity was 73.3%, the positive predictive value was 21.9% and the negative predictive value was 87.5%. At 9 months, the composite event rate was 21.9% in those with a positive ETT, 20.8% in those with an indeterminate ETT and 12.5% in those with a negative ETT (p = 0.25 positive vs. Follow-up occurred at 9 months.ĮTT results at 6 weeks were: 32 (23.5%) positive, 24 (17.6%) indeterminate and 80 (58.8%) negative. The Duke Treadmill Score (DTS) was calculated for all patients. The ETT was classified as positive, indeterminate, or negative. We examined 136 patients who underwent routine ETT at 6 weeks post-PCI in the ADORE trial. The objective of this study was to examine the impact of a routine ETT strategy early after PCI on follow-up cardiac events and procedures. There have been few prospective studies examining the utility of routine exercise treadmill testing (ETT) early after percutaneous coronary intervention (PCI). A focussed follow-up programme performing exercise test allows to determine timely possible risk of restenosis, to adapt medication doses, to reduce risk factors and to influence positively patients' compliance. A lower Robinson index (RI) was registered in the same group of patients. Restenosis was associated with ST-segment deviation in the exercise electrocardiogram.

For left main (LM) disease patients 50% of all restenosis diagnoses also were diagnosed early (three to six month after PCI). We established a patient subgroup (22%) with 'silent' ischemia (positive exercise test without chest pain), out of whom 41% had restenosis. In half of those patients above restenosis was diagnosed early - three to six months after PCI. Restenosis of coronary arteries in angiography were established in 6.4%. Seventeen percent of patients had chest pain and 13% had significant ST-segment changes in electrocardiogram. Clinical and functional status of patients and risk of restenosis were evaluated and corrections in medications were made. An exercise test was conducted one, three, six and twelve months after PCI. A total of 7,300 patients with CHD were followed-up in one year after PCI. This method has been successfully implemented in diagnostics of restenosis in coronary arteries, a process which pathophysiologically differs from primary atherosclerosis. Exercise tests are widely used for the evaluation and diagnostics of CHD. This is the first study in Latvia, and provides wide opportunities to evaluate functional status of patients, treatment effectiveness, possible risks and prognosis after PCI. A follow-up programme was developed in the Latvian Centre of Cardiology, which included a stress electrocardiogram for patients after PCI. The clinical course and prognosis of coronary heart disease (CHD) can be modified favourably with percutaneous coronary intervention (PCI) in combination with medication.

Importance of the Exercise Test Follow-up Programme for Patients with Coronary Artery Disease who Underwent Percutaneous Coronary Intervention

Sirds slimibas