Postprocedure Chest Pain

Patients who present with symptoms of an acute coronary syndrome shortly after percutaneous coronary interventions such as angioplasty or stent placement should be assumed to have had abrupt vessel closure until proven otherwise. Subacute thrombotic occlusion following stent placement occurs in approximately 4 percent of patients 2 to 14 days postprocedure. Although less common than closure following percutaneous transluminal coronary angioplasty (PTCA), it is associated with a high likelihood of major ischemic complications. Patients should be treated aggressively for an acute coronary syndrome, and cardiology or interventional cardiology consultation should be obtained. Patients with chest pain syndromes following coronary artery bypass grafting may also have abrupt vessel closure; however, symptoms of recurrent ischemia must be distinguished from post-AMI pericarditis or Dressler syndrome, as discussed above.

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