Mechanisms and diagnostic evaluation of persistent or recurrent angina following percutaneous coronary revascularization

• Published in: European heart journal Vol. 40; no. 29; pp. 2455 - 2462
• Main Authors: Crea, Filippo, Bairey Merz, Cathleen Noel, Beltrame, John F, Berry, Colin, Camici, Paolo G, Kaski, Juan Carlos, Ong, Peter, Pepine, Carl J, Sechtem, Udo, Shimokawa, Hiroaki
• Format: Journal Article
• Language: English
• Published: England 01.08.2019
• ISSN: 0195-668X; 1522-9645; 1522-9645
• DOI: 10.1093/eurheartj/ehy857

Persistence or recurrence of angina after a percutaneous coronary intervention (PCI) may affect about 20–40% of patients during short–medium-term follow-up. This appears to be true even when PCI is ‘optimized’ using physiology-guided approaches and drug-eluting stents. Importantly, persistent or recurrent angina post-PCI is associated with a significant economic burden. Healthcare costs may be almost two-fold higher among patients with persistent or recurrent angina post-PCI vs. those who become symptom-free. However, practice guideline recommendations regarding the management of patients with angina post-PCI are unclear. Gaps in evidence into the mechanisms of post-PCI angina are relevant, and more research seems warranted. The purpose of this document is to review potential mechanisms for the persistence or recurrence of angina post-PCI, propose a practical diagnostic algorithm, and summarize current knowledge gaps.