1
|
Tryfonos A, Green DJ, Dawson EA. Effects of Catheterization on Artery Function and Health: When Should Patients Start Exercising Following Their Coronary Intervention? Sports Med 2019; 49:397-416. [PMID: 30719682 DOI: 10.1007/s40279-019-01055-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Coronary artery disease (CAD) is a leading cause of death worldwide, and percutaneous transluminal coronary angiography (PTCA) and/or percutaneous coronary intervention (PCI; angioplasty) are commonly used to diagnose and/or treat the obstructed coronaries. Exercise-based rehabilitation is recommended for all CAD patients; however, most guidelines do not specify when exercise training should commence following PTCA and/or PCI. Catheterization can result in arterial dysfunction and acute injury, and given the fact that exercise, particularly at higher intensities, is associated with elevated inflammatory and oxidative stress, endothelial dysfunction and a pro-thrombotic milieu, performing exercise post-PTCA/PCI may transiently elevate the risk of cardiac events. This review aims to summarize extant literature relating to the impacts of coronary interventions on arterial function, including the time-course of recovery and the potential deleterious and/or beneficial impacts of acute versus long-term exercise. The current literature suggests that arterial dysfunction induced by catheterization recovers 4-12 weeks following catheterization. This review proposes that a period of relative arterial vulnerability may exist and exercise during this period may contribute to elevated event susceptibility. We therefore suggest that CAD patients start an exercise training programme between 2 and 4 weeks post-PCI, recognizing that the literature suggest there is a 'grey area' for functional recovery between 2 and 12 weeks post-catheterization. The timing of exercise onset should take into consideration the individual characteristics of patients (age, severity of disease, comorbidities) and the intensity, frequency and duration of the exercise prescription.
Collapse
Affiliation(s)
- Andrea Tryfonos
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Daniel J Green
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Crawley, WA, 6009, Australia
| | - Ellen A Dawson
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, L3 3AF, UK.
| |
Collapse
|
2
|
Kim HS, Kim SY, Lee UJ, Kim W. Terrible stent thrombosis induced by a treadmill test performed three days after percutaneous coronary intervention. Chonnam Med J 2014; 50:23-6. [PMID: 24855604 PMCID: PMC4022794 DOI: 10.4068/cmj.2014.50.1.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 01/09/2014] [Accepted: 01/15/2014] [Indexed: 11/24/2022] Open
Abstract
Generally, early exercise after coronary stenting is considered safe, but isolated cases of acute stent thrombosis have been associated with the performance of a treadmill exercise test after percutaneous coronary intervention (PCI). The treadmill exercise test is often used to noninvasively assess the functional result of PCI. In this report, we describe a case of terrible stent thrombosis related to an exercise test performed 3 days after stenting, and the patient died as the result of an intractable thrombus.
Collapse
Affiliation(s)
- Hyun Soo Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Se Yun Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Un Joo Lee
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Weon Kim
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| |
Collapse
|
3
|
Maraj R, Fraifeld M, Owen AN, Kotler MN, Yazdanfar S. Coronary dissection and thrombosis associated with exercise testing three months after successful coronary stenting. Clin Cardiol 2009; 22:426-8. [PMID: 10376185 PMCID: PMC6655614 DOI: 10.1002/clc.4960220614] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Exercise testing is commonly performed to assess the functional result of coronary revascularization procedures and is usually not associated with any complications. However, this report documents a rare case of coronary dissection and thrombosis, which resulted in an acute myocardial infarction, in a patient who underwent stress testing 3 months following successful coronary stent implantation.
Collapse
Affiliation(s)
- R Maraj
- Division of Cardiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania 19141, USA
| | | | | | | | | |
Collapse
|
4
|
Dagianti A, Rosanio S, Penco M, Dagianti A, Sciomer S, Tocchi M, Agati L, Fedele F. Clinical and prognostic usefulness of supine bicycle exercise echocardiography in the functional evaluation of patients undergoing elective percutaneous transluminal coronary angioplasty. Circulation 1997; 95:1176-84. [PMID: 9054847 DOI: 10.1161/01.cir.95.5.1176] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Supine bicycle exercise echocardiography (SBEE) has never been used before and early after percutaneous transluminal coronary angioplasty (PTCA) for assessing the functional outcome of the procedure and predicting late restenosis. METHODS AND RESULTS We selected 76 subjects with stable angina, normal wall motion at rest, and exercise-induced wall-motion abnormalities before PTCA. SBEE with peak exercise imaging and the use of a 16-segment, four-grade score model was performed 54 +/- 15 hours after PTCA. No exercise-related adverse events occurred. Patients were grouped according to SBEE results: group 1 (n = 35, 46%) with negative exercise ECG and echo; group 2 (n = 19, 25%) with a positive exercise ECG but normal echo; and group 3 (n = 22, 29%) with a positive exercise echo with either a positive (n = 7, 32%) or negative (n = 15, 68%) ECG. Exercise performance significantly improved in all groups. In group 3, peak wall-motion score index decreased from 1.27 +/- 0.11 before to 1.15 +/- 0.06 after PTCA (P < .05), and duration of wall-motion abnormalities went from 81 +/- 24 to 47 +/- 19 seconds (P < .05). The rate of clinical restenosis (ie, angina recurrence or positive 6-month SBEE in asymptomatic patients, both associated with angiographic restenosis > 50%) was 37%. By multiple logistic regression analysis, clinical restenosis was associated with a positive post-PTCA exercise echo (odds ratio [OR] 3.08, 95% confidence interval [CI] 1.66 to 5.72; P = .0004) and with increasing values of pre-PTCA wall-motion score index (OR 2.86, 95% CI 1.92 to 4.27; P = .005) and duration of wall-motion abnormalities (OR 2.12, 95% CI 1.07 to 4.20; P = .04). CONCLUSIONS SBEE is a safe and reliable tool to demonstrate changes in exercise-induced wall-motion abnormalities after PTCA and provides prognostic information in the risk assessment of clinical restenosis.
Collapse
Affiliation(s)
- A Dagianti
- Department of Cardiovascular and Respiratory Sciences, La Sapienza University, Rome, Italy
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Samuels B, Schumann J, Kiat H, Friedman J, Berman DS. Acute stent thrombosis associated with exercise testing after successful percutaneous transluminal coronary angioplasty. Am Heart J 1995; 130:1120-2. [PMID: 7484745 DOI: 10.1016/0002-8703(95)90217-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- B Samuels
- Department of Imaging Division of Nuclear Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | | | | | | | | |
Collapse
|
6
|
Pirelli S, Danzi GB, Massa D, Piccalo G, Faletra F, Campolo L, De Vita C. Strategy of diagnostic imaging before and after PTCA. Echocardiography 1995; 12:303-9. [PMID: 10150476 DOI: 10.1111/j.1540-8175.1995.tb00553.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
It is now widely accepted that percutaneous transluminal coronary angioplasty (PTCA) is an effective nonsurgical technique for achieving coronary revascularization. Exercise electrocardiography remains the standard procedure for functional evaluation before, early, and late after angioplasty because of its availability, safety, and limited cost. The drawback of exercise testing is its low specificity and the fact that the attainment of diagnostically useful data requires a level of exercise that substantially increases myocardial oxygen demand. Exercise thallium imaging has been shown to be highly predictive of restenosis and adverse events after angioplasty, but it is possible that myocardial perfusion may not return to normal immediately after successful revascularization. Stress echocardiography has many practical advantages over scanning tests, as result of its lower cost, shorter imaging time, and the absence of radiation exposure. Dipyridamole echocardiography testing (DET) is an exercise-independent method of evaluating patients who have to undergo coronary angioplasty. Before PTCA, DET allows the clinician to localize the site and extent of myocardial ischemia anatomically. Early after a successful procedure, DET identifies a group at high risk for the late recurrence of symptoms. Late after PTCA, DET is more accurate than exercise electrocardiography in detecting restenosis or disease progression. In asymptomatic patients with exercise-induced ST depression, DET has the same good diagnostic accuracy as thallium scintigraphy. For these reasons, as well as because of its noninvasive nature and availability, DET should be considered an attractive option for the evaluation of patients after anatomically successful angioplasty.
Collapse
Affiliation(s)
- S Pirelli
- Department of Cardiology, Niguarda Hospital, Milan, Italy
| | | | | | | | | | | | | |
Collapse
|
7
|
Meier B. Stress test early after coronary angioplasty: an old habit to be revived? CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1994; 33:340-1. [PMID: 7889554 DOI: 10.1002/ccd.1810330411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
8
|
Shah D, Lal P. Acute coronary occlusion during early post-PTCA exercise testing: a rare but avoidable risk. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1994; 33:335-9. [PMID: 7889553 DOI: 10.1002/ccd.1810330410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We describe here one instance of an acute occlusion of an angioplastied LAD coronary artery occurring during a treadmill stress test performed 2 d after the procedure. The occlusion occurred during the recovery period after a reasonably high level of stress was achieved without evidence of ischaemia. Similar instances described in the literature are summarized and discussed. In the light of these data, it might be prudent to avoid early post-PTCA exercise stress testing.
Collapse
Affiliation(s)
- D Shah
- Department of Cardiology, Apollo Hospitals, Madras, India
| | | |
Collapse
|
9
|
Goodman SG, Holloway RM, Adelman AG. Acute coronary thrombotic occlusion following exercise testing 6 weeks after percutaneous transluminal coronary angioplasty. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1992; 27:40-4. [PMID: 1525808 DOI: 10.1002/ccd.1810270110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Exercise stress testing is often performed following percutaneous transluminal coronary angioplasty (PTCA) in order to evaluate the efficacy of the procedure. Together with thallium-201 (Tl-201) scintigraphy, these noninvasive tests provide valuable data for predicting the recurrence of angina and restenosis. However, concerns regarding the safe timing of exercise testing post-PTCA have been raised in 3 previous case reports. Each case documents acute coronary occlusion shortly after stress testing performed within several days of successful angioplasty, leading to the recommendation that such testing be deferred up to 4 weeks following PTCA. This paper reports a patient in whom acute thrombotic occlusion of the left anterior descending coronary artery (LAD) occurred immediately after a mildly abnormal exercise Tl-201 stress test done 6 weeks after PTCA.
Collapse
Affiliation(s)
- S G Goodman
- Department of Medicine, Mount Sinai Hospital, University of Toronto, Ontario, Canada
| | | | | |
Collapse
|
10
|
Balady GJ, Leitschuh ML, Jacobs AK, Merrell D, Weiner DA, Ryan TJ. Safety and clinical use of exercise testing one to three days after percutaneous transluminal coronary angioplasty. Am J Cardiol 1992; 69:1259-64. [PMID: 1585856 DOI: 10.1016/0002-9149(92)91217-r] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
To evaluate both the safety and clinical use of predischarge symptom-limited exercise testing after successful uncomplicated percutaneous transluminal coronary angioplasty (PTCA), 100 patients were randomized to undergo exercise testing (n = 50) or no exercise testing (n = 50). There were no differences in clinical or angiographic characteristics between the groups. Exercise testing was performed 38 +/- 14 hours after PTCA. Patients who exercised achieved 71 +/- 12% of predicted maximal heart rate, with 38% reaching greater than or equal to stage III of the Bruce protocol. No patient in either group developed cardiac complications during 48-hour follow-up. Of the 11 patients with a positive test result, 92% had angiographically incomplete revascularization. Attending physicians (n = 16) were questioned both before and after exercise testing about when, after discharge, they would allow their patient to perform each of 11 specific activities of daily living. Questionnaires were administered to physicians at similar time frames for patients in the no-exercise group. Comparison of the responses between initial and repeat questionnaires showed that patients in the exercise group (with a test result negative for ischemia) were allowed to perform 7 of 11 activities, including return to work, earlier (p less than 0.05) than the no-exercise patients. These data indicate that in this well-defined group of patients, symptom-limited exercise testing early after PTCA appears to be safe, and alters physician management in allowing patients with a negative test result to return to various activities at an earlier date. Such testing may be useful in counseling patients after PTCA.
Collapse
Affiliation(s)
- G J Balady
- Department of Medicine, University Hospital/Boston University Medical Center, Massachusetts 02118
| | | | | | | | | | | |
Collapse
|
11
|
Bedogni F, La Vecchia L, Arfiero S, Castellani A, Vincenzi M. Acute coronary occlusion after recent coronary angioplasty. Association with exercise and successful treatment with intracoronary thrombolysis. Chest 1990; 98:505-7. [PMID: 2376192 DOI: 10.1378/chest.98.2.505] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A case of coronary occlusion occurred seven days after successful percutaneous transluminal coronary angioplasty. The acute complication occurred shortly after a negative exercise stress test and was resolved with intracoronary urokinase.
Collapse
Affiliation(s)
- F Bedogni
- Divisione Clinicizzata di Cardiologia, Università di Verona, Vicenza, Italy
| | | | | | | | | |
Collapse
|
12
|
Abstract
We performed coronary angiography within 95 minutes of the onset of symptoms in seven patients with an acute coronary event after an exercise stress test. The test was normal in six patients. Previous angiography in four patients revealed no evident or moderate obstructive coronary arterial disease. After the test, unstable angina developed in two patients, acute myocardial infarction in four and ventricular fibrillation in one, who was successfully resuscitated. At acute angiography the coronary artery involved was occluded in four and sub-totally obstructed in three. In three cases, coronary occlusion was due to thrombosis, vasospasm, or both. In six vessels there was an eccentric lesion, which is consistent with a ruptured plaque. These findings show that physical exercise can unexpectedly provoke an acute coronary event with sub-total or total occlusion of a previous angiographically normal or moderately obstructed coronary artery. The mechanism is probably related to exercise-induced plaque rupture which can produce coronary (sub)occlusion by coronary thrombosis, spasm, or both.
Collapse
Affiliation(s)
- R Ciampricotti
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | | |
Collapse
|
13
|
Tuzcu EM, Lever HM, Hollman J, Chambers JL. Acute myocardial infarction after normal maximal exercise test and reperfusion by emergency coronary angioplasty. Am Heart J 1988; 115:1124-7. [PMID: 2966549 DOI: 10.1016/0002-8703(88)90087-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- E M Tuzcu
- Department of Cardiology, Cleveland Clinic Foundation, OH 44106
| | | | | | | |
Collapse
|
14
|
Chokshi SK, Meyers S, Abi-Mansour P. Percutaneous transluminal coronary angioplasty: ten years' experience. Prog Cardiovasc Dis 1987; 30:147-210. [PMID: 2959985 DOI: 10.1016/0033-0620(87)90012-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- S K Chokshi
- Department of Internal Medicine, Northwestern University Medical School, Chicago, IL
| | | | | |
Collapse
|
15
|
Przybojewski JZ, Weich HF. Stress testing after successful percutaneous transluminal coronary angioplasty. Am J Cardiol 1987; 60:644. [PMID: 2957908 DOI: 10.1016/0002-9149(87)90322-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|