[Angioplasty with stenting in single vessel disease: non invasive methods for detecting restenosis]

To compare the value of the myocardial perfusion imaging with 99Tc sestamibi (MIBI) with clinical data and stress EKG (SEKG) variables, in the detection of angiographic restenosis (AR: lesion > 50%), in a group of patients (pts) with single vessel disease (angiographic lesion above 70% in one epicardial artery), submitted to coronary angioplasty (PTCA) with stenting.

Fifty-nine pts, followed prospectively, (49 males and 10 females aged 57 +/- 10) were submitted to 61 angioplasties, with dilatation of 59 vessels, and with stenting in 63 (1.07 stent/vessel). Clinical evaluation was performed in the first, third and sixth month, SEKG with MIBI in the fourth month and recatheterization for angiographic control in the sixth month. The pts were divided in two groups: R-positive angiographic restenosis (AR)--14 pts: NR--without AR--45 pts; the angiographic restenosis rate was 23.7%. The patients' history, cause of admission, procedure characteristics, medication at discharge, clinical events during follow-up, variables of stress EKG associated with myocardial perfusion and angiographic control were analyzed.

The cause of admission was the same in both groups (MI in R group: 28.6%; NR: 46.7%; p = ns). There was no difference in the discharge medication. The R group was more symptomatic (Angina: R = 50.0% vs NR = 11.1%; p < 0.001 clinical restenosis rate = 11.8%), and had more revascularization procedures (PTCA: R = 57.1% vs NR = 2.8%; p < 0.001/Bypass surgery: R = 14.3% vs NR = 0%; p = 0.01). This group had abnormal stress EKG more frequently (42.9 vs 20.0%, p = ns) and ischemia in the myocardial perfusion scintigraphy (57.1 vs 6.7% p < 0.001). [table: see text]

The clinical and diagnostic tests evaluated in this study showed a limited sensitivity in the detection of angiographic restenosis in a group of patients with single vessel disease submitted to coronary angioplasty and stenting. Myocardial scintigraphy was the best method for the detection of angiographic restenosis, showing a high specificity and a reasonable sensitivity.