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Early Post-Percutaneous Coronary Intervention Chest Pain: A Nationwide Survey on Interventional Cardiologists'
Yasir Taha1, Deepak L Bhatt2, Debabrata Mukherjee3
1Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA; Morehouse School of Medicine, Atlanta, GA, USA.
Insights
Early post-percutaneous coronary intervention chest pain (EPPCP) is common but poorly understood. Most interventional cardiologists favor standardized nomenclature and conservative management for this benign chest pain. Further research is needed.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Practice
Background:
- Early post-percutaneous coronary intervention chest pain (EPPCP) is a common clinical occurrence.
- Despite its prevalence, EPPCP remains understudied and lacks clear explanation in existing literature.
- This study addresses the knowledge gap by examining current perceptions of EPPCP among interventional cardiologists.
Purpose of the Study:
- To assess the current understanding and perception of early post-percutaneous coronary intervention chest pain (EPPCP) among practicing interventional cardiologists nationwide.
- To explore the perceived incidence, causes, and optimal management strategies for EPPCP.
- To evaluate the need for standardized nomenclature for EPPCP.
Main Methods:
- A nationwide survey questionnaire was developed using Survey Monkey.
- The questionnaire was emailed to practicing interventional cardiologists to gather data on their perceptions and practices regarding EPPCP.
- Data from 623 respondents were analyzed to understand current viewpoints on EPPCP.
Main Results:
- Over half of respondents (50.2%) perceive EPPCP incidence at 5-10%, with 57.5% rarely recommending repeat angiography.
- Transient microvascular dysfunction was cited as a cause by 47.1%, while 39% viewed it as a distinct entity.
- A significant majority (80%) favored reassurance and vasodilators for treatment, deeming medical management appropriate without ischemic ECG changes.
Conclusions:
- A majority of interventional cardiologists (72%) advocate for standardized nomenclature for EPPCP to improve communication.
- Current opinions on EPPCP reveal diversity in understanding, lack of standard nomenclature, and absence of practice guidelines.
- Further large-scale prospective studies are essential to elucidate EPPCP's pathophysiology, optimal management, prognosis, and reporting.
Background:
Early post-percutaneous coronary intervention chest pain (EPPCP) appears to be a common clinical phenomenon. EPPCP has not been fully explained or studied in the literature despite the abundance of clinical trials on percutaneous coronary intervention (PCI). The objective of this questionnaire-based survey is to assess the current perception of EPPCP among practicing interventional cardiologists nationwide.
Methods:
A survey questionnaire was designed utilizing the Survey Monkey tool to address the perceptions and current practices regarding key aspects of EPPCP among interventional cardiologists. The survey was sent to the interventional cardiologists via email.
Results:
The survey questionnaire regarding EPPCP was provided to 2615 practicing interventional cardiologists and resulted in 623 total survey responses, with 503 of those respondents completing all eight survey questions. A total of 50.2% of the interventional cardiologists perceive that the incidence of EPPCP is 5-10%, and 57.5% consider that repeat angiography or PCI is rarely needed (1 in 1000 cases). A total of 47.1% of the participants think that EPPCP is due to transient microvascular dysfunction, while 39% perceive it as a different entity requiring a different approach. When asked about developing a standardized labeling for the phenomenon of EPPCP, 34.8% of responders indicated that they believe EPPCP should be labeled as a benign form of chest pain/angina, and 28% preferred to describe EPPCP in non-standardized terms. Among interventional cardiologists, 80% thought that the treatment of this entity is a combination of reassurance and vasodilators and, without ischemic ECG changes, medical management is appropriate.
Conclusion:
A total of 72% of interventional cardiologists in our survey preferred to label EPPCP as standard nomenclature to facilitate communication between healthcare providers, patients and families in a consistent way. There is a diversity of opinion regarding EPPCP, no standard nomenclature, and no guideline to standardize practice. Further large-scale prospective studies are needed to better understand the pathophysiological mechanisms, optimal management strategies, prognostic implications, and clinical reporting of EPPCP.
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