Prognostic significance of severe coronary microvascular dysfunction post-PCI in patients with STEMI: A systematic review and meta-analysis

Canu, Marjorie; Khouri, Charles; Marlière, Stéphanie; Vautrin, Estelle; Piliero, Nicolas; Ormezzano, Olivier; Bertrand, Bernard; Bouvaist, Hélène; Riou, Laurent; Djaileb, Loïc; Charlon, Clémence; Vanzetto, Gérald; Roustit, Matthieu; Barone-Rochette, Gilles

doi:10.1371/journal.pone.0268330

Cited by 10 publications

(10 citation statements)

References 33 publications

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“…However, another study suggested that the bimodal shape of the thermodilution curve, rather than the index of microvascular resistance value itself, indicated an increased risk of MACEs within six months, and this might be a result of capillary obstructions [ 76 ]. A systematic review of 1094 patients further suggested that the index of hyperemic microvascular resistance and the index of microcirculatory resistance in patients with STEMI after PCI aided in the early identification and early risk stratification of severe CMD and were prognostic indicators of MACEs [ 77 ]. In addition, CMD could be a prognostic indicator of MACEs in patients with hypertrophic cardiomyopathy, obesity, aortic stenosis, or chronic kidney disease [ 59 , 78 – 80 ].…”

Section: Discussionmentioning

confidence: 99%

Global trends and frontiers in research on coronary microvascular dysfunction: a bibliometric analysis from 2002 to 2022

Gao

Meng

et al. 2022

Eur J Med Res

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Background Coronary microvascular dysfunction (CMD) is a leading cause of ischemic heart disease. Over the past few decades, considerable progress has been made with respect to research on CMD. The present study summarized the current research hotspots and trends on CMD by applying a bibliometric approach. Methods Relevant publications between 2002 and 2022 were extracted from the Web of Science Core Collection. Visualization network maps of countries, institutions, authors, and co-cited authors were built using VOSviewer. CiteSpace was used for keyword analysis and the construction of a dual-map overlay of journals and a timeline view of co-cited references. Results 1539 CMD-related publications were extracted for bibliometric analysis. The annual publications generally showed an upward trend. The United States of America was the most prolific country, with 515 publications (33.5%). Camici P. G. was the most influential author, whereas the European Heart Journal, Circulation, and Journal of the American College of Cardiology were the most authoritative journals. Research hotspot analysis revealed that endothelial dysfunction as well as reduced nitric oxide production or bioavailability played critical roles in CMD development. Positron emission tomography was the most widely used imaging method for diagnosis. In addition, microvascular angina, hypertrophic cardiomyopathy, and heart failure have attracted much attention as the main clinical implications. Furthermore, international standards for CMD diagnosis and management may be the future research directions. Conclusions This study offers a comprehensive view about the hotspots and development trends of CMD, which can assist subsequent researchers and guide future directions.

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Section: Discussionmentioning

confidence: 99%

Global trends and frontiers in research on coronary microvascular dysfunction: a bibliometric analysis from 2002 to 2022

Gao

Meng

et al. 2022

Eur J Med Res

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“…Each methods has its own strengths and weaknesses [ 7 ]. Studies have shown that the index of microcirculatory resistance (IMR) and hyperemic microvascular resistance (HMR) are useful for the early identification of severe CMD in patients with STEMI after PCI, which are associated with a higher risk of long-term MACEs in patients with STEMI [ 14 ]. However, both IMR and HMR are invasive.…”

Section: Discussionmentioning

confidence: 99%

“…Patients underwent follow-up for 13 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) months. CMD was found to be an independent predictor of all 3).…”

Section: Clinical Follow-upmentioning

confidence: 99%

Coronary microcirculation dysfunction evaluated by myocardial contrast echocardiography predicts poor prognosis in patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention

Wang

Jin

et al. 2022

BMC Cardiovasc Disord

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Background The mortality rate of acute ST-segment elevation myocardial infarction (STEMI) remains substantial, despite advances in treatment strategies. Coronary microcirculation dysfunction (CMD) persists after percutaneous coronary intervention (PCI) in a substantial proportion of STEMI patients. The association between CMD assessed using myocardial contrast echocardiography (MCE) and prognosis requires further elucidation. This study aimed to evaluate the impact of CMD after successful PCI on the prognosis of patients with STEMI. Methods We enrolled 167 patients with STEMI after PCI who underwent MCE during hospitalization between January 2018 and March 2022. Patients were classified into the CMD and non-CMD groups according to the results of MCE. The clinical data and MCE results of both groups were analyzed. Follow-up was conducted for major adverse cardiac events. Results MCE detected CMD in 105 patients (62.9%). The CMD group contained fewer hypertensive patients (55.2% versus 74.2%, P = 0.015). Patients with CMD exhibited significantly higher levels of plasma troponin I (TnI) [73.2 (23.0–124.0) versus 28.9 (12.7–80.2) ng/mL, P = 0.004], higher levels of plasma B-type natriuretic peptide [255 (99–641) versus 193 (59–389) pg/mL, P = 0.004], poorer Killip classification (P = 0.038), and different culprit vessels (P < 0.001) compared to the non-CMD group. Patients with CMD exhibited lower left ventricular ejection fraction [50 (43–58) versus 61 (54–67) %, P < 0.001], poorer wall motion score index values (1.68 ± 0.4 versus 1.31 ± 0.26, P < 0.001) and poorer left ventricular global longitudinal strain [–11.2 (–8.7 to –14.1) versus –13.9 (–11.0 to –17.2) %, P < 0.001] compared to the non-CMD group. Patients underwent follow-up for 13 (7–20) months. After adjusting for hypertension, peak TnI level, culprit vessel, and Killip classification, CMD was an independent predictor of total major adverse cardiac events at 13 months’ follow-up [adjusted odds ratio (OR), 2.457; 95% confidence interval (CI), 1.042–5.790; P = 0.040], and patients with CMD had a higher risk of hospitalization for heart failure (adjusted OR, 5.184; 95% CI, 1.044–25.747; P = 0.044) and repeat myocardial infarction (adjusted OR, 2.896; 95% CI, 1.109–7.565; P = 0.030). Conclusions MCE is a safe and effective method for detecting CMD in patients with STEMI. CMD detected by MCE after successful PCI in patients with STEMI is a common occurrence, which is associated with a significantly worse prognosis, especially hospitalization for heart failure and repeat myocardial infarction.

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“…The endpoints were all‐cause death, nonfatal MI, and combined cardiovascular events with hospitalization for heart failure, and follow‐up ranged from 6 months to 7 years. Using an index of microcirculatory resistance (IMR) > 40 or hyperemic microvascular resistance (HMR) > 3 mmHg/cm/s as an indicator for severe CMVD, the results showed that severe CMVD had a worse prognosis, with an HR of 3.42 compared with nonsevere CMVD 16 . A meta‐analysis of 46 studies showed an incidence of MINOCA of 6% (patients’ median age 55 years), which was more common in young women without hyperlipidemia, and 12‐month all‐cause mortality was lower in patients with MINOCA than MIOCA (4.7% vs. 6.7%) 17 .…”

Section: Definition Clinical Classification and Epidemiology Of Cmvdmentioning

confidence: 99%

Chinese expert consensus on the diagnosis and treatment of coronary microvascular diseases (2023 Edition)

Chen,

Ni,

Huang

et al. 2023

MedComm

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Since the four working groups of the Chinese Society of Cardiology issued first expert consensus on coronary microvascular diseases (CMVD) in 2017, international consensus documents on CMVD have increased rapidly. Although some of these documents made preliminary recommendations for the diagnosis and treatment of CMVD, they did not provide classification of recommendations and levels of evidence. In order to summarize recent progress in the field of CMVD, standardize the methods and procedures of diagnosis and treatment, and identify the scientific questions for future research, the four working groups of the Chinese Society of Cardiology updated the 2017 version of the Chinese expert consensus on CMVD and adopted a series of measures to ensure the quality of this document. The current consensus has raised a new classification of CMVD, summarized new epidemiological findings for different types of CMVD, analyzed key pathological and molecular mechanisms, evaluated classical and novel diagnostic technologies, recommended diagnostic pathways and criteria, and therapeutic strategies and medications, for patients with CMVD. In view of the current progress and knowledge gaps of CMVD, future directions were proposed. It is hoped that this expert consensus will further expedite the research progress of CMVD in both basic and clinical scenarios.

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Prognostic significance of severe coronary microvascular dysfunction post-PCI in patients with STEMI: A systematic review and meta-analysis

Cited by 10 publications

References 33 publications

Global trends and frontiers in research on coronary microvascular dysfunction: a bibliometric analysis from 2002 to 2022

Global trends and frontiers in research on coronary microvascular dysfunction: a bibliometric analysis from 2002 to 2022

Coronary microcirculation dysfunction evaluated by myocardial contrast echocardiography predicts poor prognosis in patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention

Chinese expert consensus on the diagnosis and treatment of coronary microvascular diseases (2023 Edition)

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