Chest pain early after percutaneous coronary intervention: incidence and relation to ECG changes, cardiac enzymes and follow-up events

• Published in: The Journal of invasive cardiology Vol. 13; no. 3; pp. 211 - 216
• Main Authors: Schüepp, M, Ullmer, E, Weinbacher, M, Pfisterer, M, Scholer, A, Ritz, R, Rickenbacher, P
• Format: Journal Article
• Language: English
• Published: United States 01.03.2001
• Subjects: Aged; Angina Pectoris - etiology; Angioplasty, Balloon, Coronary; Coronary Angiography; Creatine Kinase - analysis; Electrocardiography; Female; Humans; Male; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - enzymology; Myocardial Infarction - therapy; Prospective Studies; Recurrence; Risk Factors; Stents; Troponin I - analysis
• ISSN: 1042-3931

To investigate the incidence of chest pain early after percutaneous coronary interventions and its correlation with ECG changes, cardiac enzymes, clinical and procedural variables and follow-up events, we prospectively studied 199 patients (84% male; mean age, 60.1 +/- 9.4 years) after primary successful percutaneous coronary interventions (21% PTCA; 79% additional stent implantation). During the first 16 hours following the intervention, the occurrence of chest pain was noted, ECGs were recorded and serial measurements of cardiac enzymes were performed. Seventy-six patients (38%) with elevated enzyme levels at time 0 were excluded. A clinical follow-up was obtained at 6 months. Forty patients (32.5%) experienced chest pain; new ECG changes were detected in 3 (2.5%). The mean levels of all enzymes were significantly higher in patients with chest pain 16 hours after the intervention. In patients with chest pain versus those without, CK-MB mass and troponin I levels higher than twice the upper normal limit were seen in 43.6% versus 11.0% (p < 0.0001) and 45.0% versus 17.3% (p < 0.002), respectively. Elevated troponin I (< 0.004) and CK-MB mass (< 0.04) as well as presumed ischemic chest pain (< 0.03) could be identified as risk factors for recurrent chest pain during follow-up. In conclusion, chest pain was common early after percutaneous coronary interventions and correlated with elevated cardiac enzymes, suggesting peri-interventional myocardial necrosis. Elevated levels of CK-MB mass and troponin I, as well as presumed ischemic chest pain, were associated with recurrent chest pain during follow-up.