Prevalence and characteristics of coronary microvascular dysfunction in post-percutaneous coronary intervention patients with recurrent chest pain

Abstract

Background: Coronary microvascular dysfunction (CMD) and obstructive coronary artery disease (CAD) are likely to exist side-by-side, thereby probably inducing angina pectoris symptoms of some patients not effectively relieved after revascularization. We aimed to evaluate the prevalence and characteristics exhibited by CMD in patients with recurrent chest pain who received percutaneous coronary intervention (PCI) before. Methods:We conducted a single-center cross-sectional retrospective study. A total of 373 patients having received PCI were hospitalized for recurrent chest pain. Subsequently, they underwent coronary angiography and a rest/stress dynamic and routine gated myocardial perfusion imaging (MPI). At the vascular level, if any coronary artery stenosis <50% and myocardial flow reserve (MFR) <2.0 in the corresponding territory was considered to result from CMD. At the participant level, the CMD group was defined as one of the nonobstructive coronary arteries, in accordance with CMD at the vascular level.Results: A total of 102 patients were finally recruited. At the vascular level, 274 vessels were eligible for inclusion, and the proportion of CMD was 43.1% (118/274). At the participant level, 49.0% (50/102) post-PCI patients with recurrent chest pain were indicated as CAD coexisting with CMD. Body mass index (BMI), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) in CMD patients exceeded those in controls. The stress myocardial blood flow (MBF) of CMD patients was significantly decreased than controls (stress MBF of left ventricle in CMD vs. control: 1.36±0.43 vs. 2.50±0.70, P<0.01). After age adjustment, multivariate logistic regression analysis revealed that increased BMI (OR: 1.405, 95% CI: 1.048-1.882) and LDL-C (OR: 3.094, 95% CI: 1.044-9.173) showed independent correlations with CMD (P<0.05). Conclusions:The prevalence of CMD could be relatively high in post-PCI patients suffering from recurrent angina with no need for revascularization, and increased BMI and LDL-C could be independent predictors of CMD.

Coronary microvascular dysfunction and myocardial area at risk assessed by cadmium zinc telluride single photon emission computed tomography after primary percutaneous coronary intervention in acute myocardial infarction patients

“…Although the relationship between the increase in BMI and CMD is not well-established, BMI is directly proportional to blood levels of lipids, glucose, and inflammatory factors. Indeed, our previous study showed that BMI is an independent predictor of CMD in obstructive coronary artery disease ( 27 ). Previous studies using PET have shown that MFR is reduced in patients with normal CAG and asymptomatic hypercholesterolemia ( 28 ), but can be reversed by lipid-lowering medications ( 29 ).…”

Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA): Focus on Coronary Microvascular Dysfunction and Genetic Susceptibility

“…In this review, we focused on the role of CMD because it has a central role in the complex pathophysiology of MINOCA and INOCA. The assessment of coronary microcirculation may be performed invasively and non-invasively, and it should be implemented both in MINOCA/INOCA and in myocardial ischemia due to atherosclerotic disease, also because of the main pathophysiological role of CMD in patients undergoing percutaneous coronary interventions [112,113]. CMD consists of structural and functional alterations of microcirculation, which hamper the cross-talk between coronary circulation and myocardial metabolism.…”