Chest pain after percutaneous coronary intervention in patients with stable angina

Abstract

BackgroundPercutaneous coronary intervention (PCI) has been widely used to treat acute coronary syndrome but is only recommended as an additional treatment to medical therapy and risk modification in patients with refractory or progressing angina. The number of PCI in this patient population is still increasing. Post-PCI chest pain (PPCP) is one of the common problems of PCI. Its presentation and causes in patients with stable angina are poorly understood.Patients and methodsThis study retrospectively collected clinical information of 167 patients who had stable angina and underwent elective PCI, including 70 patients with PPCP 24 hours after procedure and 97 patients without PPCP. The incidence and predictors of PPCP were analyzed.ResultsThe incidence of PPCP was 41.9% (70/167). Compared with non-PPCP patients, PPCP patients had more abnormal post-PCI electrocardiogram (ECG) changes (new Q-waves, ST-segment shifts, or T-waves inversion) and serum cardiac troponin I (cTnI) elevation, more PCI vessels, and stent placement (all P<0.05). More PPCP patients required repeat revascularization than non-PPCP patients after PCI (P=0.043). PPCP was correlated with abnormal post-PCI ECG changes (P<0.0001), cTnI elevation (P<0.0001), post-PCI serum level of cTnI (P<0.0001), number of stents placed (P=0.009), and pre-PCI cTnI level (P=0.049). The strongest predictors of PPCP were abnormal post-PCI ECG changes (P<0.0001), post-PCI cTnI level (P<0.0001), and cTnI elevation (P<0.0001), followed by the number of stents placed (P=0.048).ConclusionPPCP is common in patients with stable angina in our cohort. It is associated with abnormal ECG changes, cTnI elevation, and number of stents placed.

Predictors of recurrent angina in patients with no need for secondary revascularization

“…Despite advances in medical and interventional treatments, many patients develop recurrent angina pectoris without coronary artery stenosis following complete coronary revascularization at initial PCI. [19] In the present study, 53.5% of patients developed recurrent angina pectoris following PCI without revascularization at one-year followup.…”

“…In recent studies, an elevated BMI [20] and a higher number of stents [19] increased the risk of developing recurrent angina pectoris after PCI, whereas the administration of nicorandil reduced the risk. [21] The current study is consistent with this report as we found that an elevated BMI correlated with a higher TIMI frame count.…”

Percutaneous coronary intervention and 30‐day unplanned readmission with chest pain in the United States (Nationwide Readmissions Database)

“…Chest pain after PCI may be experienced in 36% to 42% of patients undergoing both elective and emergent PCI 15‐17 . It is most commonly described in the first 24 h following PCI but is described as occurring within the first 3 weeks 16 .…”

Gastroenterological Perspectives on Acute Cardiac Care — the Management of Patients with Implanted Coronary Stents Following an Acute Coronary Syndrome

“…A high rate of post-PCI chest pain is also recorded in patients with stable CAD. In a study which included 167 patients who underwent elective PCI for stable CAD, Chang et al reported an incidence of 41.9% of post-PCI chest pain 53.…”