title: Chest pain after coronary artery stent implantation.
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.
authors.affiliation: Cattedra di Cardiochirurgia, Università di Roma Tor Vergata, Rome, Italy. francescoversaci@yahoo.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Versaci
authors.forename: Achille
authors.initials: A
authors.lastname: Gaspardone
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Tomai
authors.forename: Igino
authors.initials: I
authors.lastname: Proietti
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
authors.forename: Luigi
authors.initials: L
authors.lastname: Chiariello
authors.forename: Pier A
authors.initials: PA
authors.lastname: Gioffrè
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis* / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D002637:Chest Pain / Q000209:etiology*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000175:diagnosis*; D003329:Coronary Vasospasm / Q000175:diagnosis; D003937:Diagnosis, Differential; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015607:Stents