CHANGING FEATURES OF ANGINAL PAIN AFTER PTCA SUGGEST A STENOSIS ON A DIFFERENT ARTERY RATHER THAN RESTENOSIS

Background We recently found that patients who had had two myocardial infarctions in different myocardial regions frequently reported differ ent locations of infarct pain, whereas patients who had had two infarc ts at the same site had a similar distribution of pain. The aim of thi s study was to assess whether a different location of anginal pain may help identify patients with a new stenosis on an artery perfusing ano ther myocardial region as opposed to those with restenosis after coron ary angioplasty (PTCA). Methods and Results We studied 38 patients (59 +/- 11 years old) who underwent PTCA for single-vessel disease, with recurrence of symptoms requiring repeat coronary angiography during a 3-year follow-up. According to our inclusion criteria, angiography sho wed either a significant restenosis of the dilated lesion, with no evi dence of lesions in the other vessels (n = 26), or a new stenosis in e ither of the other coronary arteries, with no restenosis in the dilate d vessel (n = 12). Before each procedure, patients reported the locati on and radiation of anginal pain. There was no relation between locati on of pain and site of the coronary stenosis. However, none of the pat ients viith restenosis reported a different location of pain after ang ioplasty, compared with 5 patients with new stenosis (0% versus 42%, P = .002). Radiation of pain involved different areas of the body in 1 patient with restenosis and in 6 with new stenosis (4% versus 50%, P = .002). Overall, location or radiation of pain in a different body are a had a specificity of 96% and a sensitivity of 58% in detecting a ste nosis an a new artery. Conclusions A different location of anginal pai n may distinguish patients with a new coronary stenosis from those wit h restenosis after PTCA for single-vessel disease. These findings sugg est that in individual patients, differences in the location of cardia c pain may be indicative of the occurrence of ischemia in different my ocardial regions.