Prognostic Value of Coronary Microvascular Function Measured Immediately After Percutaneous Coronary Intervention in Stable Coronary Artery Disease

Abstract

Background: The prognostic impact of coronary microvascular dysfunction after percutaneous coronary intervention (PCI) remains unclear in patients with stable coronary artery disease. This study sought to investigate the prognostic value of microvascular function measured immediately after PCI in patients with stable coronary artery disease. Methods: We enrolled 572 patients with stable coronary artery disease who underwent PCI and elective measurement of the index of microcirculatory resistance (IMR) immediately after PCI from 8 centers in 4 countries. Impaired microvascular function was defined as IMR≥25 (high IMR). Major adverse cardiac events, including death, myocardial infarction (MI) and target vessel revascularization, were evaluated. Results: During a median follow-up duration of 4.0 years, the cumulative major adverse cardiac events rate was significantly higher in the high IMR group (n=66/148) compared with the low IMR group (n=128/424; hazard ratio [HR], 1.56; 95% CI, 1.16−2.105; P =0.001), primarily due to a higher rate of periprocedural MI (HR, 1.59; 95% CI, 1.11−2.28; P =0.004) but also due to higher rates of mortality (HR, 1.59; 95% CI, 0.76−3.35; P =0.22), spontaneous MI (HR, 2.10; 95% CI, 0.67−6.63; P =0.20) and target vessel revascularization (HR, 1.40; 95% CI, 0.77−2.54; P =0.27). Cumulative risk for death, spontaneous MI, and target vessel revascularization was higher in the high IMR group (HR, 1.55; 95% CI, 0.99−2.43; P =0.056), as was death and spontaneous MI alone (HR, 1.79; 95% CI, 0.96−3.36; P =0.065). On multivariable analysis, high IMR post-PCI was an independent predictor of major adverse cardiac events. Conclusions: IMR measured immediately after PCI predicts adverse events in patients with stable coronary artery disease.

Efficacy of Ranolazine for Treatment of Coronary Microvascular Dysfunction—A Systematic Review and Meta-analysis of Randomized Trials

“…1 CMD has also been shown to be associated with an increased risk of adverse cardiovascular events, including myocardial infarction (MI), heart failureerelated hospital admissions, and cardiac death. 2 Moreover, a strong female predominance for CMD exists. 3 Despite improved diagnostics, CMD still represents a challenge in terms of management for involved health care providers.…”

Simplified Assessment of the Index of Microvascular Resistance

“…Accordingly, guidelines recommend the invasive assessment of the coronary microvascular resistance in patients with angina and nonobstructive coronary artery disease [1]. CMD has a crucial role modulating patient outcomes in various clinical settings, including acute coronary syndromes, after percutaneous coronary interventions, in patients with cardiomyopathies and cardiac transplantation-related allograft vasculopathy [2][3][4][5]. Furthermore, microvascular angina negatively impacts the quality of life [6][7][8].…”

Coronary Flow Reserve and Glycemic Variability in Patients with Coronary Artery Disease

“…A validated thermodilution-derived method for assessing coronary microvascular function by measuring coronary flow and pressure simultaneously with a single coronary wire enables measurement of CFR and the index of microcirculatory resistance (IMR), which are commonly used to assess coronary microvascular function and have been shown to have prognostic implications in various cardiac conditions (27)(28)(29)(30)(31).…”