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Biomedical subjects

D B Pryor

Publications and source records attributed to D B Pryor.

At least 19 recordsLinked to original sources
PubMed1992

Mortality after coronary angioplasty and coronary artery bypass surgery (the national Medicare experience).

Mortality rates for Medicare patients who underwent coronary artery bypass surgery were compared with those who had angioplasty or angioplasty and bypass surgery. Two data sets were used for this study: The first contained information on demographic factors, co-morbidities and subsequent mortality on all 96,666 Medicare patients who had bypass surgery or angioplasty in 1985; the second contained additional detailed clinical data collected using the MedisGroups method on a random sample of 2,931 revascularization patients from 6 states. From the national data set 30-day and 1-year mortality rates were 3.8 and 8.2% for 25,423 angioplasty patients and 6.4 and 11.8% for 71,243 bypass surgery patients (p less than 0.001 for both time periods). Mortality rates for the MedisGroups data were 4.4 and 8.5% for the angioplasty patients and 6.5 and 11.9% for the bypass surgery patients. After eliminating patients admitted with a myocardial infarction, mortality rates were 1.9 and 6.0% for 632 angioplasty patients and 5.1 and 10.8% for 1,730 bypass surgery patients. The risk-adjusted relative risk of mortality for bypass surgery versus angioplasty was 1.72 (p = 0.001) for all patients, 2.15 (p less than 0.001) for low-risk patients and 0.90 (p = not significant) for high-risk patients. Results suggest that low-risk patients have better survival with angioplasty because of lower short-term mortality.

Angioplasty, Balloon, Coronary↗
PubMed1992

Referral patterns for coronary artery disease treatment: gender bias or good clinical judgment?

OBJECTIVE: To determine whether a gender bias exists in referral for coronary bypass graft surgery among patients with catheterization-documented coronary artery disease. DESIGN: Historical cohort study (1969 to 1984). SETTING: A referral medical center. PATIENTS: A total of 5795 patients with catheterization-documented coronary artery disease. MEASUREMENTS: Surgical referral patterns of men and women grouped by risk for cardiac death and by treatment effectiveness. Time trends were evaluated for three periods: 1969 to 1974, 1975 to 1979, and 1980 to 1984. RESULTS: Overall, when no adjustment was made for baseline risk for cardiac death, no statistical difference was found between men and women regarding referral for surgery (46% compared with 44%, respectively). When an adjustment was made for such risk, the male-to-female odds ratio for surgical referral was 1.28 (95% Cl, 1.05 to 1.58) among patients with a low risk for cardiac death. This effect was most evident in the 1980 to 1984 period (odds ratio, 1.73; Cl, 1.29 to 2.31). In the high-risk group, the odds ratio was 0.84 (Cl, 0.68 to 1.04), with little change occurring during the study. Men were more likely to be referred for surgery when surgery offered the least survival benefit relative to medical therapy (odds ratio, 1.29; Cl, 1.08 to 1.54). This effect was most pronounced in the 1980 to 1984 period (odds ratio, 1.63; Cl, 1.27 to 2.10). CONCLUSIONS: Women are less likely than men to be referred for coronary bypass graft surgery among patients with a low risk for cardiac death, in whom surgery offers little or no survival benefit over medical treatment. Women are at least as likely as men to be referred for bypass surgery among more symptomatic and more severely diseased patients, in whom surgery offers the greatest survival benefits. These trends were most prominent in the recent years of the study. Based on surgical survival benefits, these referral patterns may represent more appropriate treatment referral for women than men.

Coronary Artery Bypass↗
PubMed1992

Ergonovine maleate testing during cardiac catheterization: a 10-year perspective in 3,447 patients without significant coronary artery disease or Prinzmetal's variant angina.

The utility of ergonovine testing for coronary artery spasm was assessed in 3,447 patients with angiographically insignificant (less than 50% diameter stenosis) or no coronary artery disease. No patients clinically had Prinzmetal's variant angina. Overall, 4% had a positive ergonovine test result, defined by spasm causing greater than or equal to 75% focal stenosis. Complications related to ergonovine use occurred in 11 patients (0.03%). In a training sample of 1,136 patients (studied between 1980 and 1984), two independent predictors of spasm were found by using multivariate analysis: the amount of visible coronary artery disease on the coronary angiogram (p less than 0.0001) and a smoking history (p = 0.001). A model to predict spasm based on these variables was validated in a test group of 2,311 patients who received ergonovine from 1985 to 1989. This model allowed the identification of a subset of 400 patients in the validation sample who had a 10% positive test rate compared with a 2% positive test rate in the remaining patients. These results should permit clinicians who use provocative testing in the catheterization laboratory to reserve testing for the subset of this group of patients most likely to have abnormal findings.

Angina Pectoris, Variant↗
PubMed1992

Prognosis in cardiogenic shock after acute myocardial infarction in the interventional era.

OBJECTIVES: The purpose of this study is to describe the outcome in cardiogenic shock treated with aggressive reperfusion therapy and to identify factors predictive of in-hospital and long-term mortality. BACKGROUND: Cardiogenic shock is the most common cause of death in patients admitted to the coronary care unit. Although studies have reported lower mortality rates in shock treated with angioplasty, few studies have described a cohort of patients with shock who were not selected because they were most likely to benefit from reperfusion therapy. METHODS: A consecutive series of 200 patients admitted with acute myocardial infarction complicated by cardiogenic shock were studied. RESULTS: The in-hospital mortality rate was 53%. Variables with significant univariable association with in-hospital death included patency of the infarct-related artery, patient age, lowest cardiac index, highest arteriovenous oxygen difference and left main coronary artery disease. The most important independent predictors of in-hospital death were patency of the infarct-related artery, cardiac index and peak creatine kinase, MB fraction. The mortality rate in patients with patent infarct-related arteries was 33% versus 75% in those with closed arteries and 84% in those in whom arterial patency was unknown. Patients who survived to hospital discharge were followed up for a median of 2 years, with a mortality rate of 18% after 1 year. The best descriptors of the relation between these variables and postdischarge mortality included age, peak creatine kinase, ejection fraction and patency of the infarct-related artery. CONCLUSIONS: In a large consecutive series of patients with cardiogenic shock with complete follow-up, patency of the infarct-related artery was most strongly associated with in-hospital and long-term mortality. This finding supports an aggressive interventional strategy in patients with cardiogenic shock.

Academic Medical Centers↗
PubMed1992

Identification of patients with coronary disease at high risk for loss of employment. A prospective validation study.

BACKGROUND: Work disability is common in patients with coronary artery disease and adversely affects both economic well-being and quality of life. The purpose of this study was to construct a model to predict premature departure from the work force of patients with coronary disease and to validate this model prospectively in an independent cohort of patients. METHODS AND RESULTS: We enrolled 1,252 coronary disease patients referred for diagnostic cardiac catheterization who were less than age 65, employed, and without prior coronary angioplasty or coronary bypass surgery. Medical, functional, psychological, economic, and job-related variables were measured at the time of baseline diagnostic cardiac catheterization, and all patients were followed for 1 year. Three hundred twelve patients underwent percutaneous transluminal coronary angioplasty (PTCA) within 60 days of catheterization, and 449 had coronary artery bypass graft surgery (CABG) within 60 days of catheterization. The remaining 491 patients were treated with initial medical therapy. Logistic regression was used to develop a multivariable model for predicting 1-year work status in the training sample patients (872 patients enrolled between March 1986 and February 1989). This model was then validated in the independent prospective test sample (380 patients enrolled between March 1989 and June 1990). Eight factors were independent predictors of departure from the work force: lower initial functional status (as assessed by the Duke Activity Status Index), followed by older age, black race, presence of congestive heart failure, lower education level, presence of extracardiac vascular disease, poorer psychological status, and lower job classification. Standard clinical variables provided only 20% of the total predictive information available from the model about follow-up work outcomes, whereas functional measures provided 27%, and demographic and socioeconomic measures provided 45%. In the test sample, the area under the receiver operating characteristic curve for the model predictions was 0.74, compared with 0.80 in the training sample, and model predictions agreed well with observed prevalences of return to work. After adjustment for baseline imbalances, there was no significant difference in 1-year return-to-work rates among the patients receiving initial PTCA or CABG therapy versus initial medical therapy. CONCLUSIONS: Patients with coronary disease who are at high risk for premature departure from the work force can be accurately identified from a combination of medical and nonmedical risk factors. The model developed in this study provides a tool to identify patients at high risk for premature loss from the work force. Such patients may benefit from special multidimensional intervention programs designed to preserve work status. Our data show that revascularization with either PTCA or CABG is not, by itself, sufficient to accomplish this goal.

Angioplasty, Balloon, Coronary↗
PubMed1992

Observational comparison of event-free survival with medical and surgical therapy in patients with coronary artery disease. 20 years of follow-up.

BACKGROUND: The purpose of this study was to describe the long-term event-free survival patterns of patients with significant coronary artery disease treated medically versus patterns of those treated surgically and to evaluate the factors associated with improved event-free survival. METHODS AND RESULTS: We studied the results of 5,824 patients undergoing medical and surgical therapy for ischemic heart disease from 1969 to 1984, with follow-up to 1991. Events considered for this evaluation were nonfatal myocardial infarction or cardiovascular death. The Cox proportional hazards model was used to determine factors differentially affecting surgical event-free survival. The survival benefits previously reported for bypass surgery in this population were largely preserved when event-free survival was examined. The two factors associated with significant event-free survival benefits for surgically treated patients were more severe coronary artery disease and a more recent surgery data. Patients with more severe coronary obstruction had a greater relative improvement with surgery in event-free survival than did patients with less severe anatomic disease. Event-free survival with surgery progressively improved over the period of the study and, by 1984, was significantly better than medical therapy for most patient subgroups. Patients with poor prognosis because of risk factors such as older age, severe angina, or left ventricular dysfunction had a risk reduction with surgery proportional to their overall risk under medical therapy. CONCLUSIONS: Higher-risk patients with more severe disease (due to either coronary disease or other risk factors and age) should be considered for coronary revascularization because it is in these patients that coronary artery bypass graft surgery has the greatest impact in reducing future cardiovascular events.

Cardiac Catheterization↗
PubMed1991

Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease.

BACKGROUND: The treadmill exercise test identifies patients with different degrees of risk of death from cardiovascular events. We devised a prognostic score, based on the results of treadmill exercise testing, that accurately predicts outcome among inpatients referred for cardiac catheterization. This study was designed to determine whether this score could also accurately predict prognosis in unselected outpatients. METHODS: We prospectively studied 613 consecutive outpatients with suspected coronary disease who were referred for exercise testing between 1983 and 1985. Follow-up was 98 percent complete at four years. The treadmill score was calculated as follows: duration of exercise in minutes--(5 x the maximal ST-segment deviation during or after exercise, in millimeters)--(4 x the treadmill angina index). The numerical treadmill angina index was 0 for no angina, 1 for nonlimiting angina, and 2 for exercise-limiting angina. Treadmill scores ranged from -25 (indicating the highest risk) to +15 (indicating the lowest risk). RESULTS: Predicted outcomes for the outpatients, based on their treadmill scores, agreed closely with the observed outcomes. The score accurately separated patients who subsequently died from those who lived for four years (area under the receiver-operating-characteristic curve = 0.849). The treadmill score was a better discriminator than the clinical data and was even more useful for outpatients than it had been for inpatients. Approximately two thirds of the outpatients had treadmill scores indicating low risk (greater than or equal to +5), reflecting longer exercise times and little or no ST-segment deviation, and their four-year survival rate was 99 percent (average annual mortality rate, 0.25 percent). Four percent of the outpatients had scores indicating high risk (less than -10), reflecting shorter exercise times and more severe ST-segment deviation; their four-year survival rate was 79 percent (average annual mortality rate, 5 percent). CONCLUSIONS: The treadmill score is a useful and valid tool that can help clinicians determine prognosis and decide whether to refer outpatients with suspected coronary disease for cardiac catheterization. In this study, it was a better predictor of outcome than the clinical assessment.

Adult↗
PubMed1991

Prediction of death and myocardial infarction by radionuclide angiocardiography in patients with suspected coronary artery disease.

The prognostic value of radionuclide angiocardiography was examined in patients with suspected coronary artery disease. Nine hundred and eight patients who underwent rest and exercise radionuclide angiocardiography without subsequent cardiac catheterization were followed for a median of 4.6 years. Fifty-two cardiovascular deaths and 28 nonfatal myocardial infarctions occurred during the follow-up period. Thirty-nine radionuclide angiocardiographic and clinical variables were analyzed in association with the end points of cardiovascular death, total cardiac events and death from all causes using the Cox proportional hazards model and Kaplan-Meier survival estimates. Univariable analysis identified the exercise ejection fraction as the best predictor of cardiovascular death (chi-square = 82), total cardiac events (chi-square = 84) and death from all causes (chi-square = 66). A small subset of patients (n = 45) with an exercise ejection fraction less than 0.35 were at high risk for future cardiac events, whereas most patients (n = 776) had an exercise ejection fraction greater than or equal to 0.50 and a low probability of a subsequent event. Three variables--the exercise ejection fraction, the exercise change in heart rate, and gender--contained independent prognostic information determined by multivariable analysis. The exercise ejection fraction was the strongest independent predictor (p less than 0.0001) for every end point. The measurement of ventricular function during exercise provides important independent prognostic information in patients with suspected coronary artery disease. Radionuclide angiocardiography successfully identifies patients requiring invasive assessment, and the low probability of cardiac events in patients with good exercise ventricular function obviates the need for interventional therapy.

Adult↗
PubMed1991

Methods for the analysis and assessment of clinical databases: the clinician's perspective.

Innovative approaches to analysing clinical databases can be considered from a perspective of innovations that improve the analytical approach or from a more global perspective in which clinical databases themselves are evaluated as a technology. The analytic approach for using a database to estimate risk can be considered as a matrix of three methodologic concerns: the predictive method; the assessment of the quality of the predictions; and the assessment of the validity or generalizability of the predictions. Considering databases as a technology places in perspective the merit of clinical databases and defines their potential value to the health care system. An awareness of both the clinical and analytic problem encourages innovation and can lead to creative solutions to the many problems present in the analysis of clinical databases.

Clinical Medicine↗
PubMed1991

Using ordinal logistic regression to estimate the likelihood of colorectal neoplasia.

The utility of ordinal logistic regression in the prediction of colorectal neoplasia was demonstrated in a group of 461 consecutive patients undergoing colonoscopy in a community practice. One hundred twenty-nine patients had adenomatous polyps and 34 had colorectal adenocarcinoma. An ordinal logistic regression model developed in a random subset (292 patients) identified five predictors of colorectal neoplasia. Colorectal neoplasia risk could be predicted using the patient's age, sex, hematocrit, fecal occult blood test result and indication for colonoscopy. The risk of colorectal neoplasia in the remaining subset of patients (169) could be reliably estimated from the model. Ordinal logistic regression analysis in this select group of patients can accurately estimate the likelihood of colorectal neoplasia. Because the generalizability of our findings are unknown, the model should not be applied to other patients. However, application of this technique to an unselected group of patients not already referred for colonoscopy could provide unbiased estimates of colorectal neoplasia risk in individual patients.

Adenocarcinoma↗
PubMed1991

Identification of acute myocardial infarction patients suitable for early hospital discharge after aggressive interventional therapy. Results from the Thrombolysis and Angioplasty in Acute Myocardial Infarction Registry.

BACKGROUND: Very early (day 4) hospital discharge has recently been proposed for selected patients with acute myocardial infarction (MI). The purpose of this study was to determine the most useful factors for identifying acute MI patients treated with aggressive interventional therapy who could be safely discharged on day 4. METHODS AND RESULTS: We studied 708 patients enrolled in the Thrombolysis and Angioplasty in Acute Myocardial Infarction trials I-III. Patients dying in the first 3 days and those with early (days 1-3) emergency coronary artery bypass graft surgery (CABG), late elective CABG (greater than or equal to day 4), or urgent/emergency CABG resulting from a late elective coronary angioplasty were excluded. The remaining 580 patients were randomly divided into a training sample (group 1) that was used to build a logistic regression model for predicting the absence of a late major complication and a test sample (group 2) that was used to validate this model. For this study, patients were considered appropriate for day 4 hospital discharge if they did not experience any of the following for 30 days after MI: death, reinfarction, cardiogenic shock, pulmonary edema, sustained hypotension, sustained ventricular tachycardia, high-grade atrioventricular block, acute ventricular septal defect, and recurrent ischemia necessitating urgent CABG. In group 1, four variables were independent predictors of freedom from late major complications: absence of early sustained ventricular tachycardia or ventricular fibrillation, absence of early sustained hypotension or cardiogenic shock, fewer coronary arteries with significant (greater than or equal to 75%) stenosis, and a higher left ventricular ejection fraction. In group 2, 23% of patients had a logistic model prediction of a 3% or less chance of a late complication. These patients had no deaths or reinfarctions by day 30 and a 3% late major complication rate. CONCLUSIONS: The results of early cardiac catheterization and the absence of selected early (days 1-3) major complications do allow identification of a low risk subgroup of acute MI patients that may be suitable for very early discharge.

Angioplasty, Balloon, Coronary↗
PubMed1991

Changing efficacies of coronary revascularization.

Our results suggest that coronary artery bypass grafting prolongs life in patients with coronary artery disease. How much depends upon their underlying coronary anatomy and the underlying medical risk of the patient. These results provide a consistent framework for interpreting the results of the randomized clinical trials and the observational results reported from the CASS registry. All of the reported information is consistent with this interpretation. Our results further suggest that improvements in the efficacy of coronary artery bypass grafting are present. This improvement appears due not only to improvements in operative survival but also to improvements in the long-term survival of operative survivors (21), (23). Thus, the results at Duke would suggest that some of the decline observed nationally in coronary heart disease mortality is due to an improvement in survival of patients undergoing coronary artery bypass grafting. While the numbers of procedures are insufficient to account for a large part of the trend (1), (23), (29) our results do suggest that an increasing proportion of it may be due to coronary artery bypass grafting. Whether the results found at Duke can be generalized more broadly is an issue. Both the insurance industry and medical practice have a great stake in understanding the prognostic risk of an individual and how that risk is modified by treatment. There is also a great need to understand how that risk may be changing as a result of changes in technology. Where will this information come from? Randomized trials typically are performed for only limited periods of time and are not well suited to capture the moving target of technology as it changes. Databases like the one at Duke are useful in capturing the performance of the technology in an academic center but whether or not these results can be translated to the effectiveness of a given therapy in the overall community is not clear. Administrative databases that capture the broad experience of the community often fail to capture sufficient clinical detail to permit examination of such issues. There is a great need for large representative databases of information that include reasonably detailed clinical profiles, descriptions of therapies patients have received, and the long-term outcomes patients have experienced. Without such information, the influence on mortality and morbidity of therapeutic interventions will be difficult to detect and improvements in the performance of the technologies virtually impossible to recognize. It will not be easy to create such an information resource but it is even more difficult to justify not having it.

Coronary Artery Bypass↗
PubMed1991

Exercise radionuclide angiocardiography predicts cardiac death in patients with coronary artery disease.

The purpose of this investigation was to document the relative importance of three clinical and three radionuclide variables for prediction of cardiac death in a consecutive group of patients evaluated for coronary artery disease. During a 6 1/2-year period, beginning in January 1978, 2,042 consecutive patients underwent radionuclide angiocardiography, with a clinical diagnosis of coronary artery disease, at Duke University Medical Center. A subgroup of 318 patients who underwent surgical myocardial revascularization near the time of initial study were excluded from later analysis. Clinical follow-up information was complete in a group of 1,663 patients who did not undergo interventional therapy. The 141 cardiac deaths in these 1,663 patients were the study end point. Cox proportional hazards models analyzed the prognostic information contained in three clinical variables (pain type, age, and sex) and three radionuclide angiocardiogram variables (exercise ejection fraction, resting end-diastolic volume, and change in heart rate with exercise). One-variable models confirmed the prognostic importance of each of these six variables. A multivariable model in which all six variables were used showed clinical variables to contain only 5% and the radionuclide variables 95% of the prognostic information. The exercise ejection fraction was the single most important variable, which alone contained 85% of the total information in the model. Curves relating probability of no cardiac death to the exercise ejection fraction identified a value of 0.50 as an inflection point. Patients with exercise ejection fractions below 0.50 demonstrate a probability of cardiac death that increases as the ejection fraction decreases.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1991

Determinants of early versus late cardiac death in patients undergoing coronary artery bypass graft surgery.

Most analyses of risk factors affecting survival after coronary artery bypass graft surgery have not differentiated among factors that influence early and late survival. For this reason, a multiphase model was applied to survival data from 2,967 patients undergoing a first coronary artery bypass graft at the Duke University Medical Center between 1969 and 1984. There were 709 deaths during follow-up to 19.6 years. The data were analyzed using a multivariable survival model that separates the underlying hazard function into as much as three different phases, each incorporating separate risk factors. Two distinct phases were detected. One phase dominated early survival (0-1 year), and the second phase dominated late survival (greater than 1 year). Surgery performed earlier in our experience was associated with elevated risk of dying in both phases but with different magnitudes, whereas lower ejection fraction, greater extent of coronary disease, older age, conduction abnormality, and history of hypertension were associated with elevated risk of dying similarly in both phases (p less than 0.05). Severity of angina symptoms and lower weight were associated with an elevated risk of dying only in the early phase (p less than 0.05; because few of the patients were obese, estimates of the relative risk of morbid obesity could not be estimated), whereas vascular disease, diabetes, and extent of myocardial damage were associated with an elevated risk of dying only in the late phase (p less than 0.05). These data illustrate both the differential influence of risk factors over time and the importance of multiphase models.

Cohort Studies↗
PubMed1991

Estimating the likelihood of severe coronary artery disease.

PURPOSE: To determine which clinical characteristics obtained by a physician during an initial clinical examination are important for estimating the likelihood of severe coronary artery disease, and to determine whether estimates based on these characteristics remain valid when applied prospectively and in different patient groups. PATIENTS AND METHODS: We examined clinical characteristics predictive of severe disease in 6,435 consecutive symptomatic patients referred for suspected coronary artery disease between 1969 and 1983. RESULTS: Eleven of 23 characteristics were important for estimating the likelihood of severe coronary artery disease. A model using these characteristics accurately estimated the likelihood of severe disease in an independent sample of 2,342 patients referred since 1983. The model also accurately estimated the prevalence of severe disease in large series of patients reported in the literature. CONCLUSIONS: These findings suggest that the clinician's initial evaluation can identify patients at high or low risk of anatomically severe coronary artery disease. Cost-conscious quality care is encouraged by identifying patients at higher risk for severe coronary artery disease who are most likely to benefit from further evaluation.

Adult↗
PubMed1990

Effect of Type A behavior on exercise test outcome in coronary artery disease.

The outcome of the diagnostic exercise test depends on such patient-related factors as age, maximum exercise heart rate, exercise time and severity of the underlying coronary artery disease (CAD). This study examined the hypothesis that type A behavior would affect the amount of effort expended, as indicated by the exercise time and the maximum heart rate achieved, thereby resulting in differences in exercise test outcome. A total of 1,260 patients with suspected CAD, all of whom had coronary angiography, a structured interview to assess type A behavior and a treadmill exercise test, participated. Of these patients, 818 (65%) had significant CAD, and 852 (68%) were type A. There were no differences between type A and B patients in either maximum heart rate or total exercise time. Among both type A and B subjects, 36% of treadmill tests were positive. Exercise test sensitivity was similar for both groups (69% for type A vs 72% for type B, p = 0.39). Similarly, specificity was similar for both groups (87% for type A vs 80% for type B, p = 0.09). Results did not change after using logistic regression to control for potential confounding factors. Thus, type A behavior does not need to be taken into account when interpreting exercise test outcome.

Adult↗
PubMed1990

Detection of restenosis after elective percutaneous transluminal coronary angioplasty using the exercise treadmill test.

To determine the value of a 6-month exercise treadmill test for detecting restenosis after elective percutaneous transluminal coronary angioplasty (PTCA), 303 consecutive patients with successful PTCA and without a recent myocardial infarction were studied. Among the 228 patients without interval cardiac events, early repeat revascularization or contraindications to treadmill testing, 209 (92%) underwent follow-up angiography, and 200 also had a follow-up treadmill test and formed the study population. Restenosis (greater than or equal to 75% luminal diameter stenosis) occurred in 50 patients (25%). Five variables were individually associated with a higher risk of restenosis: recurrent angina (p = 0.0002), exercise-induced angina (p = 0.0001), a positive treadmill test (p = 0.008), more exercise ST deviation (p = 0.04) and a lower maximum exercise heart rate (p = 0.05). However, only exercise-induced angina (p = 0.002), recurrent angina (p = 0.01) and a positive treadmill test (p = 0.04) were independent predictors of restenosis. Using these 3 variables, patient subsets could be identified with restenosis rates ranging from 11 to 83%. The exercise treadmill test added independent information to symptom status about the risk of restenosis after elective PTCA. Nevertheless, 20% of patients with restenosis had neither recurrent angina nor exercise-induced ischemia at follow-up. For more accurate detection of restenosis, the exercise treadmill test must be supplemented by a more definitive test.

Angiography↗