Prognostic value of non-invasive functional tests during the follow-up of acute myocardial infarction treated with primary coronary stenting / Valor prognóstico de provas funcionais na evolução tardia de pacientes com infarto agudo do miocárdio tratados com angioplastia coronária transluminal percutânea primária com implante de stent

AUTOR(ES)
DATA DE PUBLICAÇÃO

2007

RESUMO

Primary coronary angioplasty and stenting during acute myocardial infarction is the first treatment choice. Non-invasive testings have been used in the diagnosis of restenosis but its efficacy and time to be performed have to be determined. The purpose of this study was to evaluate exercise treadmill test, myocardial perfusion imaging and rest two-dimensional echocardiogram in the diagnosis of restenosis in patients treated during the first 12 hours of STelevation myocardial infarction.Methods: From August 2003 to January 2006, 64 patients were selected after primary coronary angioplasty and stenting. Rest two- dimensional echocardiogram, exercise treadmill test associated to right precordial leads and myocardial perfusion imaging according to GATED-SPECT were performed 6 weeks (step 1), 6 months (step 2) and one year (step 3) after the procedure.Coronary angiography was performed during the sixth month of follow-up.Results : Mean age was 56.2 ± 10.2 years; 53 patients were male. Single vessel disease >= 50% was observed in 46.9% of patients. The left anterior descending coronary artery was treated in 48.4%, the right coronary artery in 34.4%, the left circumflex in 10.9%, the left main coronary artery in 3.1%, a large diagonal branch in 1.6% and saphenous vein graft in 1.6% of the cases. Angiographic restenosis occurred in 28.8% from 59 patients submitted to coronary angiography. Mean left ventricular ejection fraction observed during rest two-dimensional echocardiogram was: 0.55 (step 1), 0.55 (step 2) and 0.56 (step 3). It was observed in patients with and without restenosis a significant difference in the left ventricular ejection fraction one year after the procedure (p= 0.003). Exercise treadmill test sensitivity, specificity, positive and negative predictive values and accuracy were respectively: 53.3%, 69%, 38.1%, 80.6% and 64.9% in step 1(p=0.123); 54.5%, 70.7%, 33.3%, 85.3% and 67.3% in step 2 (p=0.159) and 38.5%, 66.7%, 27.8%, 76.5% and 59.6% in step 3 (p=0.747). Right precordial leads did not show any additional significance. Sensitivity, specificity, positive and negative predictive values and accuracy during myocardial perfusion imaging when considering summed difference score >2 were respectively: 40%, 78.6%, 40%, 78.6% and 68.4% in step 1(p=0.185); 54.5%, 87.8%, 54.5%,87.8% and 80.8% in step 2(p=0.006) and 25%, 91.7%, 50%, 78.6% and 75% in step 3(p=0.156). When considering summed difference score >4 they were respectively: 13.3%, 88.1%, 28.6%, 74% and 68.4% in step 1(p>0.999); 36.4%, 95.1%,66.7%, 84.8% and 82.7% in step 2 (p=0.014) and 8.3%, 94.4%, 33.3%, 75.6% and 72.9% in step 3(p>0.999). Conclusions: Exercise treadmill test did not allow to discriminate restenosis in this population in all steps.Myocardial perfusion imaging performed 6 months after acute myocardial infarction was associated to restenosis. Patients with restenosis showed lower left ventricular ejection fraction one year after acute myocardial infarction by rest two-dimensional echocardiogram.

ASSUNTO(S)

angioplasty transluminal percutaneous coronary echocardiography teste de esforço prognóstico angioplastia transluminal percutânea coronária exercise test myocardial infarction reestenose coronária radionuclide imaging coronary restenosis infarto do miocárdio ecocardiografia cintilografia prognosis

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