Angina and Percutaneous Coronary Intervention: a review

Following percutaneous coronary intervention, 20-40% of patients experience persistent or recurrent angina. This impacts patient morbidity, as well as them economically – they are often faced with recurrent hospitalisations or hospital visits, as well as higher levels of medication. Angina post-percutaneous coronary intervention can occur due to many reasons, including coronary stretch pain, diffuse coronary disease, stent thrombosis and many other causes, but angina is often overlooked. Furthermore, possible causes such as myocardial bridges are frequently overlooked too in patients. To aid this issue, full analyses and evaluations of past medical and coronary intervention histories must be performed on all patients. Also, understanding the exact timings of the pain experienced by the patients may prove helpful. Clinically, non-invasive tests such as the treadmill stress test, stress echocardiogram or nuclear stress test can be applied. Invasive testing, such as coronary angiography, could be used if the results from the stress tests are abnormal, or if there are suspected complications. After testing, individualised management is required for all patients, including lifestyle changes, as well as both pharmacological and non-pharmacological treatments.

This review by Ajmal M et al. aimed to understand the causes behind persistent or recurrent angina post-percutaneous coronary intervention, as well as what could be done to resolve this issue.

Key learnings

A full management strategy, using both invasive and non-invasive testing methods, will help to diagnose and manage persistent or recurrent angina after percutaneous coronary intervention. Following this, a phenotype-guided management style with specific lifestyle changes, pharmacological and non-pharmacological factors can be used to aid the patient.