Coronary flow reserve measured by myocardial perfusion imaging in patients after PCI

Abstract

Background Despite achieving complete revascularization, patients with coronary artery disease (CAD) may still experience adverse outcomes, potentially attributed to the presence of coronary microvascular dysfunction (CMD). This phenomenon can be evaluated through the assessment of coronary flow reserve (CFR), which reflects the arteries on the epicardium and the microcirculation of the coronary system. A reduced CFR following complete revascularization indicates the presence of CMD. Our objective is to measure CFR values in patients who have undergone complete revascularization by percutaneous coronary intervention (PCI) using myocardial perfusion imaging (MPI) and analyze the prevalence of CMD and its correlation factors. Methods Clinical data and essential information from patients admitted to TEDA International Cardiovascular Hospital were collected between March 2020 and March 2022. MPI was utilized to assess CFR, while coronary angiography was performed during their hospitalization. CMD is diagnosed when there is less than 50% stenosis in the epicardial artery, accompanied by a regional CFR of under 2.0. A logistic regression model was established to analyze the correlation factors of CMD. Results According to the experiment's criteria for inclusion and exclusion, we ultimately included 323 patients. Among the enrolled patients, the incidence of CMD was 46.7% (151/323).Through binary logistic regression analysis, we found that the history of myocardial infarction (OR = 1.973 95% CI:1.106–3.521), hyperlipidemia (OR = 2.202 95% CI:1.323–3.666), and diabetes (OR = 1.765 95% CI:1.079–2.889) were significant correlates of CMD (P < 0.05). Conclusions CMD is a common occurrence in patients who have undergone PCI and achieved complete revascularization, especially in those with comorbidities such as myocardial infarction, hyperlipidemia, and diabetes. Post-PCI assessment of CFR is essential, and perioperative prevention strategies aimed at reducing the incidence of CMD are beneficial for improving patient outcomes.