[Probability analysis of the value of ergometry in the detection of restenosis after coronary angioplasty].
To evaluate the usefulness of treadmill exercise test in the diagnosis of coronary restenosis, we have chosen a sequential and probabilistic analysis. The rate of coronary restenosis found in the sample (n = 213) was of 30%. This initial probability of having restenosis was radically changed by the recurrence of typical angina: 77% in patients with this symptom, 17% in those without (p < 0.001). In contrast, the qualitative result of the exercise test was unable to change significantly the probabilities established after anamnesis. This was due to a lower specificity for exercise test (76%) than for angina (93%), the sensibility being the same (56%) for both. Employment of a discriminant value that integrates different ergometric variables did not enhanced sensibility, but allowed the identification of a good number of false positive results and therefore palliated the negative impact of faulty specificity. Being applied to a "discordant group" (no angina/positive exercise test, n = 34) was able to achieve a significant change in probability: from 15% to 50% or 4% (p < 0.01), according to the discriminant being lesser or greater than a preestablished value. In conclusion, prevalence of the event and evaluation of symptomatology are both important to estimate the probability of suffering coronary restenosis. On the contrary, exercise test, in the absence of a weighty method, adds more confusion than clarity to the analysis of the problem. Our results can be used to improve the follow-up of patients who have been successfully dilated by angioplasty.
Tercedor
L
L
Servicio de Cardiología, Hospital Virgen de las Nieves, Granada.
Melgares
R
R
Prieto
J A
JA
Romero
J A
JA
Rosas
G
G
Azpitarte
J
J
D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D005080:Exercise Test / Q000706:statistics & numerical data*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D012008:Recurrence; D012680:Sensitivity and Specificity
Análisis probabilístico del valor de la ergometría en la detección de reestenosis tras angioplastia coronaria.