Persistence or recurrence of angina after percutaneous coronary intervention (PCI) has gained recognition as an unfortunately common condition, which defeats the most frequent purpose of performing PCI in patients with stable coronary artery disease, the relief or reduction of anginal symptoms. Many aspects of this problem remain unknown and underexplored, with clinical practice guidelines providing limited information on guidance for its causative diagnosis, prevention and management. This review article aims to provide a contemporary perspective on the problem of post-PCI angina, leveraging recent advancements on the pathophysiological mechanisms that frequently underlie this condition, including sub-optimal functional results of PCI and non-obstructive causes of myocardial ischaemia. The opportunities provided by new functional coronary angiography tools are explored. A practical structured approach to the aetiological diagnosis and treatment of these patients is proposed.
Keywords: Angina; Functional coronary angiography; INOCA; Intracoronary imaging; Intracoronary physiology; Percutaneous coronary intervention.
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