Predictors of recurrent angina in patients with no need for secondary revascularization

BACKGROUND: Approximately 20% to 30% of patients with coronary artery disease (CAD)develop recurrent angina pectoris following successful and complete coronary revascularization utilizingpercutaneous coronary intervention (PCI). We aim to investigate predictors of recurrent angina pectorisin patients who have undergone successful coronary revascularization using PCI, but on repeat coronaryangiography have no need for secondary revascularization.METHODS: The study comprised 3,837 patients with CAD, who were enrolled from January2007 to June 2019. They had undergone successful PCI;some of them redeveloped anginapectoris within one year after the procedure, but on repeat coronary angiography had no need forrevascularization. Thrombolysis in myocardial infarction (TIMI) frame count was used to evaluatethe velocity of coronary blood in the follow-up angiogram. Multivariate logistic regression was usedto investigate risk factors for recurrent angina pectoris. Similarly, predictors of recurrent anginaaccording to the TIMI frame count were assessed using multivariate linear regression.RESULTS: In this retrospective study, 53.5% of patients experienced recurrent angina pectoris.By multivariate logistic regression, the following characteristics were statistically identified as riskfactors for recurrent angina pectoris: female sex, older age, current smoking, low-density lipoproteincholesterol (LDL-C) ≥1.8 mmol/L, and an elevated TIMI frame count (P for all <0.05). Similarly, usingmultivariate linear regression, the statistical risk factors for TIMI frame count included: female sex,older age, diabetes, body mass index (BMI), post-procedural treatment without the inclusion of dualantiplatelet therapy.CONCLUSIONS: Patient characteristics of female sex, older age, diabetes, and elevated BMIare associated with an increased TIMI frame count, coronary microcirculation dysfunction, and recurrentangina pectoris after initially successful PCI. In addition, current smoking and LDL-C ≥1.8 mmol/L arerisk factors for recurrent angina pectoris. In contrast, the treatment with dual antiplatelet therapy isnegatively correlated with a higher TIMI frame count and the risk of recurrent angina pectoris.