Related Experiment Videos
Frequency and outcome of chest pain after two new coronary interventions (atherectomy and stenting)
M Mansour1, J P Carrozza, R E Kuntz
1Cardiovascular Division, Charles A. Dana Research Institute, Boston, Massachusetts.
Insights
Chest pain after new device interventions like stenting is common. Electrocardiogram changes indicate higher risk, but patients without them may not need urgent repeat angiography.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- New device interventions, including Palmaz-Schatz stenting and Simpson directional atherectomy, are frequently performed.
- Post-procedural chest pain is a recognized complication.
Purpose of the Study:
- To investigate the incidence, predictors, and implications of chest pain following new device interventions.
- To determine the utility of urgent repeat coronary angiography in patients experiencing post-procedural chest pain.
Main Methods:
- Retrospective analysis of 464 new device interventions in 410 patients between June 1988 and July 1991.
- Evaluation included electrocardiograms, cardiac isoenzymes, and selective urgent repeat coronary angiography.
- Statistical analysis to identify factors associated with chest pain.
Main Results:
- Chest pain occurred in 23% of patients within 72 hours post-procedure.
- Electrocardiographic changes were sensitive markers of angiographic abnormality.
- Non-Q-wave myocardial infarction occurred in 5% of patients.
- Lower residual percent stenosis, incomplete revascularization, and multivessel disease were associated with chest pain.
- Vessel dissection after stenting, but not atherectomy, was linked to chest pain.
Conclusions:
- Chest pain is a common complication after new device interventions.
- Electrocardiographic changes predict higher risk but not in-hospital mortality.
- Urgent recatheterization may not be necessary for patients with chest pain but without electrocardiographic changes.
Abstract:
Between June 1988 and July 1991, 464 new device interventions (Palmaz-Schatz stent or Simpson directional atherectomy) were performed in 410 patients. Chest pain occurred within 72 hours after the procedure in 94 patients (23%). All patients were evaluated with electrocardiograms and cardiac isoenzymes on the day after the procedure, and urgent repeat coronary angiography was performed in 29 chest pain patients (31%). Whereas all 14 patients with abnormal findings on repeat angiography had electrocardiographic changes, 6 of the 20 restudied patients (30%) with electrocardiographic changes had no angiographic explanation for chest pain. Non-Q-wave myocardial infarction occurred in 22 patients (5%) (10 of 35 [29%] with chest pain and electrocardiographic changes, 3 of 44 [7%] with chest pain and no electrocardiographic change, and 9 of 316 [3%] without chest pain). Factors associated with chest pain after new device intervention included a decreased residual percent stenosis (p = 0.05), incomplete revascularization (p = 0.005) and the presence of multivessel disease (p = 0.001). Vessel dissection after stenting but not atherectomy was associated with postprocedure chest pain. Chest pain is common (23%) after new device intervention. Electrocardiographic changes are a sensitive marker of angiographic abnormality and confer a higher risk of non-Q-wave myocardial infarction, but no increase of in-hospital mortality. Determinants of postprocedure chest pain are lower residual percent stenosis, incomplete revascularization and the presence of multivessel disease. Patients with chest pain but no electrocardiographic changes early after successful stent placement or atherectomy need not routinely undergo urgent recatheterization.