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.