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CLINICAL STUDY: MYOCARDIAL INFARCTION AND ACUTE CORONARY SYNDROME

Postprocedure chest pain after coronary stenting: implications on clinical restenosis

^* Cardiac Catheterization Laboratory of the Zena & Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York, USA

Manuscript received March 27, 2002; revised manuscript received July 18, 2002, accepted September 20, 2002.

^* Reprint requests and correspondence: Dr. Samin K. Sharma, Mount Sinai Hospital, Box 1030, One Gustave Levy Place, New York, New York 10029-6574, USA.
samin.sharma{at}msnyuhealth.org

OBJECTIVES: 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.

Abbreviations and Acronyms   ACC/AHA   American College of Cardiology/American Heart Association   CI   confidence interval   CK-MB   creatine kinase-MB isoenzyme   ECG   electrocardiogram   GPI   glycoprotein IIb/IIIa inhibitors   LAD   left anterior descending coronary artery   MACE   major adverse cardiac events   MI   myocardial infarction   MLD   minimum lumen diameter   OR   odds ratio   PCI   percutaneous coronary intervention   PPCP   postprocedure chest pain   TnI   troponin I   TVR   target vessel revascularization

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