Chest pain after coronary interventional procedures. Incidence and pathophysiology

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Chest pain post-percutaneous coronary intervention (PCI) is frequent, causing patient and staff distress.
• Potential causes include acute coronary artery closure, spasm, myocardial infarction, or local trauma.
• Distinguishing benign from hazardous causes is critical for appropriate patient management.

Purpose of the Study:

• To differentiate the causes of chest pain following coronary interventional procedures.
• To highlight the significance of non-ischemic chest pain, particularly after stent implantation.

Main Methods:

• Review of clinical presentations and outcomes of patients experiencing chest pain after PCI.
• Analysis of data from registries like the National Heart, Lung, and Blood Institute PTCA Registry.
• Comparison of chest pain incidence and causes between percutaneous transluminal coronary angioplasty (PTCA) and newer interventions like stenting.

Main Results:

• A minority of post-procedural chest pain cases are due to ischemic events.
• Coronary artery spasm, occlusion, or myocardial infarction occur in a small percentage of patients.
• Non-ischemic chest pain, potentially 'stretch pain' from stent implantation, is more common (41% vs. 12% after PTCA).

Conclusions:

• Chest pain after coronary interventions requires careful evaluation to rule out ischemia.
• Non-ischemic 'stretch pain' is a significant consideration, especially after coronary stent placement.
• Recognizing diverse origins of cardiac chest pain is essential for effective clinical management.