Angioplasty: stress testing is not very helpful at detecting restenosis

Clinical bottom line (level 1a)

  1. Exercise treadmill ECG is not very helpful at diagnosing or ruling out restenosis in patients with a recent PTCA.
  2. Thallium scanning can help detect (LR + 3.9) and rule out restenosis (LR - 0.16) , but further testing may be required.
  3. Stress echocardiography can help diagnose restenosis (LR + 4.9) , but further testing may be required.
Garzon and Eisenberg: Can J Cardiol 2001; 17 : 41-48
Expires March 2004

The study

Systematic review of all diagnostic studies of
  • Patients: recent PTCA
  • Intervention: stress testing: exercise treadmill ECG, stress nuclear imaging, stress echocardiography compared with coronary angiography
  • Outcome: restenosis
Articles found in English using Medline, 1875 to 2000 (search terms: PTCA, angioplasty, detection, restenosis, functional testing, exercise testing, sestamibi, thallium, echocardiography ) and searching reference lists of retrieved artcles.

Selection criteria: by 2 independent reviewers - differences were solved by consensus
Appraisal criteria: independent reference standard, application to all patients
Articles excluded if:
  • no follow-up functional testing at 6 months
  • no follow-up coronary angiogram at 6 months
  • sensitivity or specificity not reported
  • study population with prior stress testing or proven restenosis on angiography before stress test
  • functional test done with pharmacological agents


13 studies found
Results were combined using a random-effects model.

The evidence

diagnostic test sensitivity for
restenosis > 50%
(95% CI)		 specificity for
restenosis > 50%
(95% CI)		 LR+ LR-
exercise treadmill testing 46%
(33% to 58%) 		77%
(67% to 86%) 		1.9 0.71
thallium scanning 87%
(74% to 100%) 		78%
(74% to 81%) 		3.9 0.16
stress echocardiography 73%
(65% to 80%) 		90%
(85% to 95%) 		4.9 0.43
total
 

Comments

  1. Studies varied greatly in terms of the selection of the study population, including whether patients were symptomatic; the length of time between the PTCA, the functional test and the coronary angiogram; and the definition of restenosis

Citation

  1. Garzon P, and Eisenberg MJ: functional testing for the detection of restenosis after percutaneous transluminal coronary angioplasty: a meta-analysis. Can J Cardiol 2001; 17 : 41-48
Search Terms: from ACP Journal Club
Contributor: Chris Ball, March 2002
Reviewer:

Clinical Question.
Patient recent PTCA and suspected restenosis
Intervention or Exposure cardiac stress testing
Outcome restenosis