SILENT ISCHEMIA AFTER CORONARY ANGIOPLASTY - EVALUATION OF RESTENOSIS AND EXTENT OF ISCHEMIA IN ASYMPTOMATIC PATIENTS BY TOMOGRAPHIC TL-201 EXERCISE IMAGING AND COMPARISON WITH SYMPTOMATIC PATIENTS

One hundred sixteen patients were evaluated to determine the ability of single photon emission computed tomographic (SPECT) thallium-201 exercise and redistribution imaging to detect silent ischemia secondary to restenosis in asymptomatic patients after single and multiple vessel percutaneous transluminal coronary angioplasty and the findings were compared with SPECT imaging detection of restenosis in symptomatic patients. The value of exercise electrocardiography (ECG) and the amount of ischemic myocardium in symptomatic and asymptomatic patients were determined. Forty-one patients were asymptomatic after angioplasty; 77% of these had chest pain before angioplasty. Seventy-five patients had chest pain after angioplasty; 99% of these had chest pain before angioplasty. Restenosis occurred in 61% of asymptomatic and 59% of symptomatic patients and in 46% of the vessels in both asymptomatic and symptomatic patients. Sensitivity, specificity and accuracy for detection of restenosis by SPECT in individual patients were 96%, 75% and 88% versus 91%, 77% and 85%, respectively, in the asymptomatic versus symptomatic groups (p = NS). Sensitivity, specificity and accuracy for restenosis detection in individual vessels were 90%, 89% and 89% versus 84%, 77% and 84%, respectively, in the asymptomatic and symptomatic groups (p = NS), with similar results for the three major arteries. Sensitivity and accuracy of exercise ECG were significantly less than those of SPECT imaging for the patients with silent (40% and 44%) and symptomatic (59% and 64%) ischemia (p < 0.001). Restenosis of vessels in the patients with silent and symptomatic ischemia was associated with an equal amount and degree of severity of ischemic myocardium in the two groups. It is concluded that 1) restenosis may occur without angina despite the presence of angina before coronary angioplasty. 2) Exercise ECG is inaccurate in detecting silent ischemia resulting from restenosis. 3) SPECT accurately identifies restenosis in both asymptomatic and symptomatic patients. 4) The amount of ischemic myocardium does not differ in silent and symptomatic restenosis.