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Transient myocardial ischemia during Holter registration before and after coronary angioplasty
S R Johansson1, M Sánez, H Emanuelsson
1Department of Cardiology, University of Göteborg, Sahlgrenska Hospital, Sweden.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) significantly reduces transient myocardial ischemia (TM) in stable angina patients. However, TM can still occur post-PTCA, without predicting restenosis.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diagnostic Monitoring
Background:
- Stable angina pectoris is often treated with revascularization procedures.
- Assessing the effectiveness of these procedures in reducing myocardial ischemia is crucial.
- Continuous Holter ST analysis offers a potential method for evaluating ischemia.
Purpose of the Study:
- To evaluate the impact of percutaneous transluminal coronary angioplasty (PTCA) on myocardial ischemia.
- To assess the utility of continuous Holter ST analysis in patients undergoing PTCA.
Main Methods:
- Forty-one patients with stable angina pectoris underwent 24-hour Holter monitoring before and after PTCA.
- Transient myocardial ischemia (TM) was defined by specific ST depression criteria.
- Successful PTCA was defined as a technical success rate.
Main Results:
- PTCA was successful in 90% of patients.
- The incidence of transient myocardial ischemia (TM) significantly decreased post-PTCA (32% vs. 68%).
- TM after successful PTCA did not correlate with subsequent restenosis.
Conclusions:
- Transient myocardial ischemia (TM) is prevalent in stable angina and decreases after successful PTCA.
- TM can persist post-PTCA, even in uncomplicated cases, potentially due to spasm or thrombosis in single-vessel disease or incomplete revascularization in multivessel disease.
- TM following PTCA is not a reliable predictor of restenosis.
Purpose:
Revascularizing procedures like percutaneous transluminal coronary angioplasty (PTCA) aim at reducing the incidence and severity of myocardial ischemia. To evaluate this, continuous Holter ST analysis is a possible method.
Design:
41 patients (35 men, 6 women) with stable angina pectoris had continuous twenty-four-hour two-channel Holter registration (V5/aVF-analogous leads) recorded before and after PTCA. Transient myocardial ischemia (TM) was defined as 0.1 mV ST depression or more 80 msec after the J point for one minute or more.
Findings:
PTCA was successful for 37 patients (90%). Eleven of these had a total of 53 episodes of TM, 36 (68%) before and 17 (32%) after PTCA (p less than 0.05). Fifteen episodes (28%) were symptomatic, and 38 (72%) were asymptomatic. Six patients had TM after successful PTCA, 5 of whom had one-vessel disease and a clinically uncomplicated course. One patient had multivessel disease, with only one vessel dilated. Follow-up angiograms for 9 of the 11 patients with TM revealed 5 restenoses. There was no significant correlation between TM after PTCA and subsequent restenosis (p greater than 0.05).
Implications:
TM is common in patients with stable angina pectoris. The incidence significantly decreases after successful PTCA, but TM is seen also with a clinically uncomplicated course. In multivessel disease this is consistent with incomplete revascularization, whereas in single-vessel disease the most likely cause is intermittent spasm or thrombosis. TM after successful PTCA does not seem to be a predictor of restenosis.