[Usefulness and safety of early stress test after coronary angioplasty]

Exercise stress test before hospital discharge in patients treated with percutaneous transluminal coronary angioplasty (PTCA) has been used from the beginning of this technique to know the immediate clinical results, although there is not enough and clear information about the prognostic value and the possible complications related to this procedure. The objective of this study was to determine the safety and prognostic value of an early stress test post PTCA in our Hospital. In a retrospective fashion the charts of consecutive patients treated with PTCA were reviewed, with selection of those in whom a stress test was done in the first 10 days after the procedure. From 224 consecutive patients with PTCA, 83 (34%) had pre discharge stress test (mean age 52.8 +/- 9.7 years, 84% were male). In all 83, the PTCA procedure was successful in 112 lesions. 78% were treated for one vessel, and 19 and 2.5% in two or three vessels respectively. Stress tests were done at 5.1 days (range 2 to 10) and in 27 (32%) the tests were done in the first 3 days. There were no local vascular complications at the puncture site, and none of the patients had angina or myocardial infarction related to the test. There were 4 positive early tests (5%). Of them, in two cases there was incomplete revascularization. In all four cases, the thallium perfusion test was positive, and restenosis was seen in three of the cases at 3 to 6 months. The remaining patient is in class I, with minor inferolateral ischemia and the treating physician decided not to recatheterized her. Eight patients (9%) with negative pre discharge stress test had a positive one at control. Of them, three had angiographic control, and two had restenosis. It can be concluded that an early stress test post PTCA is safe, and can be done before discharge, with the possible exception of those with high risk of acute reocclusion. A positive result do not implicate immediate recatheterization, but can be associated with a major probability of late persistent myocardial ischemia and restenosis.