Postprocedure chest pain after coronary stenting: implications on clinical restenosis.
OBJECTIVE
The goal of this study was to analyze the incidence and predictors of postprocedure chest pain (PPCP) after percutaneous coronary intervention (PCI) and its correlation with clinical restenosis.


BACKGROUND
Chest pain after PCI occurs frequently even in the absence of procedural events and is considered to be due to vasospasm or coronary artery stretch. The short- and long-term significance of PPCP after otherwise successful stenting is not clear.


METHODS
We analyzed 1,362 patients undergoing coronary stenting for PPCP, procedural and in-hospital events, 30-day major adverse cardiac events, and target vessel revascularization (TVR) at 6 to 9 months.


RESULTS
There were 488 patients with PPCP and, of these, 312 patients were excluded due to procedural events. The remaining 176 patients with PPCP were compared with 874 patients without PPCP. Creatine kinase-MB isoenzyme elevation occurred in 25.6% of the PPCP group versus 9.6% of the no PPCP group (p < 0.001). Despite similar reference vessel diameter, the PPCP group had larger postprocedure minimum lumen diameter, higher stent-to-vessel ratio, and higher inflation pressure versus the no PPCP group (p < 0.01). At 30 days, the emergency room visits and repeat catheterization (16% vs. 2.7%; p < 0.001) were higher in the PPCP group versus the no PPCP group, but repeat intervention was similar. At 6- to 9-month follow-up, the TVR was significantly higher in the PPCP group compared with the no PPCP group (29.5% vs. 16.6%; p < 0.01).


CONCLUSIONS
Our analysis suggests micromyonecrosis and vessel stretch as causes of PPCP. Postprocedure chest pain is associated with similar short-term outcome as no PPCP, but has higher restenosis, perhaps mediated by deep vessel wall injury. Therefore, PPCP may identify patients at high risk for restenosis.
Kini
Annapoorna S
AS
Cardiac Catheterization Laboratory of the Zena & Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York 10029, USA.
Lee
Paul
P
Mitre
Cristina A
CA
Duffy
Mary E
ME
Sharma
Samin K
SK
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D017225:Atherectomy, Coronary / Q000009:adverse effects*; D002637:Chest Pain / Q000453:epidemiology / Q000209:etiology*; D023903:Coronary Restenosis / Q000453:epidemiology* / Q000209:etiology; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D005260:Female; D006801:Humans; D015994:Incidence; D007527:Isoenzymes / Q000097:blood; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology; D009204:Myocardial Revascularization; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011237:Predictive Value of Tests; D012306:Risk; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors
D007527:Isoenzymes; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form