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Chest pain after coronary artery stent implantation
Francesco Versaci1, Achille Gaspardone, Fabrizio Tomai
1Cattedra di Cardiochirurgia, Università di Roma Tor Vergata, Rome, Italy. francescoversaci@yahoo.it
Insights
Chest pain after coronary stent implantation, even without restenosis, is linked to heightened coronary vasoreactivity. This suggests abnormal blood vessel response contributes to post-procedure angina in some patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- A significant number of patients experience chest pain post-coronary artery stent implantation, despite successful procedures and absence of in-stent restenosis.
- This post-procedural chest pain, occurring without restenosis, is a recognized but not fully understood clinical phenomenon.
Purpose of the Study:
- To investigate the underlying mechanisms of chest pain in patients following successful coronary artery stent implantation, specifically in cases without evidence of in-stent restenosis.
- To assess the role of coronary vasoreactivity and potential vasospasm in the development of post-stent chest pain.
Main Methods:
- The study included 57 patients with stable angina undergoing successful stent implantation.
- Chest pain characteristics were evaluated pre-procedure and during a 6-month follow-up.
- Patients without in-stent restenosis underwent an intracoronary ergonovine test to assess coronary vasoreactivity.
Main Results:
- Fifteen patients reported chest pain during follow-up; 6 had myocardial ischemia/in-stent restenosis.
- Nine patients experienced chest pain without in-stent restenosis; 8 of these had pain reproduced by ergonovine.
- Patients with ergonovine-induced pain showed significantly greater vasoconstriction with ergonovine and vasodilation with nitroglycerin compared to asymptomatic patients.
Conclusions:
- Chest pain, similar to habitual angina, occurs in approximately one-fifth of patients post-stent implantation without in-stent restenosis.
- This condition appears to be associated with exaggerated coronary vasoreactivity, indicating abnormal vascular responses.
- Findings suggest that altered coronary vasoreactivity plays a role in the etiology of chest pain in the absence of restenosis after stenting.
Abstract:
A sizeable proportion of patients who undergo successful coronary artery stent implantation experiences chest pain immediately after the procedure and/or in the following months in the absence of in-stent restenosis. We investigated this phenomenon in 57 consecutive patients with stable angina who underwent successful stent implantation. Chest pain characteristics were assessed before stent implantation and during 6-month follow-up. All patients underwent coronary angiography within 6 months of the procedure 48 hours after exercise thallium-201 perfusion scintigraphy. Patients who did not exhibit in-stent restenosis underwent an ergonovine test at the end of routine coronary angiography. During follow-up, 15 patients complained of chest pain. Six of these patients exhibited scintigraphic evidence of myocardial ischemia and in-stent restenosis at angiography. In the remaining 9 patients, chest pain occurred in the absence of in-stent restenosis at angiography. In 8 of these patients intracoronary ergonovine administration reproduced their habitual pain, whereas it did not cause any pain in the 42 patients who were completely asymptomatic at follow-up and without in-stent restenosis. Ergonovine caused more intense vasoconstriction and nitroglycerin caused more intense vasodilation of the reference coronary diameter in patients with than in patients without ergonovine-induced pain (-17 +/- 3 vs -9 +/- 3%, p <0.001; 9 +/- 6 vs 5 +/- 4%, p <0.02, respectively). In conclusion, chest pain with features similar to habitual angina occurs in the absence of in-stent restenosis in 1/5 of patients after stent implantation and appears to be associated with more intense coronary vasoreactivity.