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Correlation between angiographic success and functional improvement assessed by exercise test following percutaneous
12nd Department of Cardiovascular Diseases, University La Sapienza, Rome, Italy.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) improved exercise tolerance in patients with stable effort angina. However, anatomical success in reducing coronary stenosis did not always correlate with functional improvements shown by exercise tests.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Stable effort angina and single-vessel disease are common cardiovascular conditions.
- Percutaneous transluminal coronary angioplasty (PTCA) is a primary intervention for coronary artery disease.
Purpose of the Study:
- To evaluate the functional outcomes of PTCA in patients with stable effort angina.
- To assess the correlation between anatomical success and functional improvement after PTCA.
Main Methods:
- Sixty-one patients with stable effort angina and single-vessel disease underwent successful PTCA.
- Exercise tests (ET) were performed before and after PTCA to assess functional capacity.
- Anatomical success was defined as >= 20% reduction in coronary stenosis.
Main Results:
- PTCA significantly increased total exercise duration and maximal double product post-procedure.
- Positive exercise tests decreased from 70% pre-PTCA to 24% post-PTCA.
- Lower stenosis reduction in patients with positive post-PTCA ET suggests a weak correlation between anatomical and functional success.
Conclusions:
- PTCA effectively improves exercise tolerance in most patients with myocardial ischemia.
- The study highlights a potential discrepancy between anatomical success criteria and actual functional improvement assessed by exercise testing.
Abstract:
Sixty-one consecutive patients with stable effort angina and single vessel disease underwent successful (reduction of coronary stenoses by greater than or equal to 20%) percutaneous transluminal coronary angioplasty (PTCA). Anatomical results were analysed on the basis of functional evaluation obtained by exercise test (ET) 1 week before (pre-PTCA) and within 1 month after (post-PTCA) PTCA. Total exercise duration and maximal double product significantly increased after PTCA (4.5 +/- 1 min vs 6.9 +/- 1.5 min, p less than 0.001 and 14.1 +/- 3.6 x 1000 mmHg x bpm vs 18 +/- 4.2 x 1000 mmHg x bpm, p less than 0.001). Pre-PTCA ET was positive in 43 patients (70%) and post-PTCA ET in 15 (24%). In patients with post-PTCA positive ET, mean stenosis diameter reduction was significantly lower than that obtained in patients with negative post-PTCA ET (29.6 +/- 8.9% vs 61.1 +/- 18.8%, p less than 0.001). In conclusion, PTCA improved exercise tolerance in the majority of patients with myocardial ischemia, however the definition of anatomical success used in this study appears to be poorly correlated with functional improvement as assessed by ET.