Liuda Brogienė, Agnė Klimaitė, Arnas Lukošiūnas, Martynas Paliokas, Andrius Macas


Background and Goal of study. Pain after percutaneous coronary intervention (PCI) is underestimated problem, which has a lack of attention. In this study we report the prevalence, pain intensity and predisposing factors of acute and chronic pain after PCI procedure. Material and methods. The Data of randomly selected patients who underwent elective PCI using transradial or transfemoral approach in Hospital of Lithuanian University of Health Sciences Kaunas Clinics Cardiology department from March to July of 2015 was collected. Patients were questioned according to survey made by authors. Pain intensity was evaluated according to verbal analogue scales (no pain -NP, mild -mP, moderate – MP severe -SP, very severe -VSP and worst possible pain -WPP) 2, 12, 24 and 48 hours after PCI. Patients were interviewed after 1 week, 1 and 3 months after PCI when they were discharged. Pain manifestation and duration time was divided in three groups: acute postoperative pain (pain occured during first 48 hours after PCI), acute prolonged pain (patients felt pain more than 48 hours, but less than 3 months after PCI), chronic pain (pain lasted more than 3 months after PCI). We investigated factors that may have influence for development of pain such as: in- site hematoma, patient age, body mass index >25, gender, arterial hypertension, arterial bleeding from puncture site, diabetes mellitus, signs of the presence of cardiovascular disease time, dyslipidaemia, PCI duration, location of intervention, fear before procedure, smoking, depression, pain during procedure, intervention wound pressure time after PCI. Data analysis was performed with SPSS 23.0. P<0.05 were used. Results. This study includes 191 participants, 122 males (63.87%) and 69 females (36.13%), who were examined first 48 hours after PCI in the hospital. Patients age – 67.3 ± 10.49 years. 150 patients (78.53%) were catheterized via radial artery, 41 patients (21.47%) – via femoral artery. Comparing pain occurrence between PCI through radial artery and through femoral artery there was no statistically significant relation. 102 participants (53.4%) felt acute pain at least one time during first 48 hours after procedure. 44 patients (23.04%) felt pain immediately after PCI: 13.64% (n= 6) of them experienced mP, 43.18% (n=19) – MP, 29.55% (n=13) – SP, 6.82% (n=3) – VSP, 6.82% (n=3) – WPP. 90 patients (47.12%) felt pain after 2 hours following PCI: 13.33% (n=12) of them experienced mP, 37.78% (n=34) – MP, 24.44% (n=22) – SP, 15.56% (n=14) – VSP, 8.89% (n=8) – WSP. 62 patients (32.46%) felt pain after 12 hours following PCI: 38.71% (n=24) of them experienced mP, 37.10% (n=23) – MP, 14.52% (n=9) – SP, 3.23% (n=2) – VSP, 6.45% (n=4) – WPP. 28 patients (14.66%) felt pain after 24 hours following PCI: 39.29% (n=11) of them experienced mP, 28.57% (n=8) – MP, 17.86% (n=5) – SP, 10.71% (n=3) – VSP, 3.57% (n=1) – WPP. 18 patients (9.42 %) felt pain after 48 hours following PCI: 33.33% (n=6) of them experienced mP, 33.33% (n=6) – MP, 11.11% (n=2) – SP, 16.67% (n=3) – VSP, 5.56% (n=1) – WPP. In most cases patients characterized the pain as dull (32.23%), prickling (28.10%) and tight (31.82%). Factors that statistically significantly affect the manifestation of acute postprocedural pain are: arterial hypertension (p=0.015), female gender (p=0.014), fear before procedure (p=0.005), hematoma (p=0.000248), arterial bleeding from puncture site (p=0.005), intervention site pain during PCI (p=0.000003). 117 participants of 191 were included in follow-up group. There were 74 males (63.25%) and 43 females (36.75%)). Patients mean age – 67.3±10.49 years. 92 patients (78.63%) catheterized through radial artery, 25 patients (21.37%) – through femoral artery. There was no statistically significant relation of the results comparing between PCI through radial artery and PCI through femoral artery. 14 patients (11.97 %) felt prolonged acute pain after 1 week following PCI: 21.43% (n=3) of them experienced mP, 28.57% (n=4) – MP, 28.57% (n=4) – SP, 14.29% (n=2) – VSP, 7.14% (n=1) – WSP. 14 patients (11.97%) felt pain after 1 month following PCI: 28.57% (n=4) of them experienced mP, 42.86% (n=6) – MP, 28.57% (n=4) – SP. Factors that statistically significantly affect the manifestation of acute prolonged pain are: smoking (p=0.016), puncture location changes during procedure (p=0.007), hematoma (p=0.0003), intervention site pain during PCI (p=0.002). For 5 patients (4.27%) pain persisted more than 3 months following PCI: 20% (n=1) of them experienced MP, 80% (n=4) – SP. Patients characterised pain as dull (60%) or prickling (40%). Factors affecting the chronic pain manifestation statistically significant are: lower diastolic blood pressure (p=0.034), puncture location changes during procedure (p=0.028), hematoma (p=0.05) and PCI duration >30 min. (p=0.013). Conclusion. This study revealed that more than half (53.4%) patients are suffering from acute postprocedural pain. In most cases this pain was referred as dull, prickling and tight felling. Statistically reliable causes for acute postprocedural pain manifestation after PCI during first 48 hours are: arterial hypertension, female gender, fear before procedure, hematoma, arterial bleeding and intervention site pain during PCI. Statistically significant risk factors for acute prolonged pain manifestation after PCI are: smoking, puncture location changes during procedure, hematoma, intervention site pain during PCI. Chronic pain developed for 4.27% of the cases. In most cases this pain was referred as dull or prickling. Factors that statistically significant affect chronic pain occurrence are: lower diastolic blood pressure, puncture location changes during procedure, hematoma, PCI duration >30 min. Still more randomised multicentre study needed.

Keyword(s): acute pain; chronic pain; local pain after percutaneous coronary intervention (PCI); local pain risk factors; local compications after PCI.
DOI: 10.5200/sm-hs.2017.007
Full TextPDF