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Angina after percutaneous coronary interventions

Marco Lombardi1,2, Laurie-Anne Boivin-Proulx1,3, Adrian Jerónimo1

  • 1Department of Interventional Cardiology, Hospital Clínico San Carlos IDISSC, Complutense University of Madrid and CIBER-CV, Calle del Prof Martín Lagos, s/n, Madrid 28040, Spain.

European Heart Journal
|October 17, 2025
PubMed

Insights

Persistent angina after percutaneous coronary intervention (PCI) is common. This review explores underlying causes, diagnostic tools, and management strategies for post-PCI angina to improve patient outcomes.

Area of Science:

  • Cardiology
  • Interventional Cardiology

Background:

  • Persistent angina after percutaneous coronary intervention (PCI) is a frequent complication in patients with stable coronary artery disease.
  • Current clinical practice guidelines offer limited guidance on the diagnosis, prevention, and management of post-PCI angina.
  • The underlying pathophysiological mechanisms and optimal therapeutic strategies remain underexplored.

Purpose of the Study:

  • To provide a contemporary perspective on the issue of post-PCI angina.
  • To review recent advancements in understanding the pathophysiological mechanisms of post-PCI angina.
  • To propose a structured approach for etiological diagnosis and treatment.

Main Methods:

  • Literature review focusing on recent advancements in pathophysiology and diagnostic tools.
  • Exploration of new functional coronary angiography techniques.
  • Development of a structured diagnostic and treatment algorithm.

Main Results:

  • Sub-optimal functional results of PCI and non-obstructive causes of myocardial ischemia are key contributors to post-PCI angina.
  • Novel functional coronary angiography tools offer improved diagnostic capabilities.
  • A structured approach can guide the etiological diagnosis and management.

Conclusions:

  • Post-PCI angina is a significant clinical challenge requiring further investigation and refined management strategies.
  • Understanding the pathophysiology and utilizing advanced diagnostic tools are crucial for effective treatment.
  • The proposed structured approach aims to optimize the care of patients experiencing angina after PCI.

Keywords:
AnginaFunctional coronary angiographyINOCAIntracoronary imagingIntracoronary physiologyPercutaneous coronary intervention

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