Chest pain after coronary interventional procedures - Incidence and pathophysiology

Citation
A. Jeremias et al., Chest pain after coronary interventional procedures - Incidence and pathophysiology, HERZ, 24(2), 1999, pp. 126-131
Citations number
33
Categorie Soggetti
Cardiovascular & Respiratory Systems
Journal title
HERZ
ISSN journal
03409937 → ACNP
Volume
24
Issue
2
Year of publication
1999
Pages
126 - 131
Database
ISI
SICI code
0340-9937(199904)24:2<126:CPACIP>2.0.ZU;2-6
Abstract
Chest pain following successful percutaneous coronary interventions is a co mmon problem. Although the development of chest pain after coronary interve ntions may be of benign character, it is disturbing to patients, relatives and hospital staff. Such pain may be indicative of acute coronary artery cl osure, coronary artery spasm or myocardial infarction, but may also simply reflect local coronary artery trauma. The distinction between these causes of chest pain is crucial in selecting optimal care. Management of these pat ients may involve repeat coronary angiography and additional intervention. Commonly repeat coronary angiography following percutaneous transluminal co ronary angioplasty (PTCA) in patients with chest pain demonstrates widely p atent lesion sites suggesting that the pain was due to coronary artery spas m, coronary arterial wall stretching or was of non-cardiac origin. As repor ted by the National Heart, Lung and Blood Institute PTCA Registry, 4.6% of patients after angioplasty have coronary occlusions, 4.8% suffer a myocardi al infarction, and 4.2% have coronary spasm. The frequency of chest pain af ter new device coronary interventions (atherectomy and stenting) seems to b e even higher. However, only the minority of patients with post-procedural chest pain have indeed an ischemic event. Therefore, the vast majority of p atients have recurrent chest pain without any signs of ischemia. There is s ome evidence that non-ischemic chest pain after coronary interventions is m ore common after stent implantation as compared to PTCA (41% vs. 12%). This may be due to the continuous stretching of the arterial wall by the stent as the elastic recoil occurring after PTCA is minimized. In conclusion, che st pain after coronary interventional procedures may potentially be hazardo us when due to myocardial ischemia. However, especially after coronary sten t placement, cardiologists must consider "stretch pain" due to the overdila tion and stretching of the artery caused by the stent in the differential d iagnosis. Clinically, it is, therefore, important to recognize that in addi tion to ischemia-related chest pain other types of chest pain do exist with cardiac origin.