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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Prevalence and characteristics of coronary microvascular dysfunction in post-percutaneous coronary intervention
Lijun Cui1,2, Liju Han1,2, Jiao Wang2,3
1Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin, China.
Insights
Coronary microvascular dysfunction (CMD) is prevalent in patients with recurrent chest pain after percutaneous coronary intervention (PCI). Increased BMI and LDL-C are independent predictors of CMD, highlighting the need for targeted management strategies.
Area of Science:
- Cardiology
- Vascular Biology
- Diagnostic Imaging
Background:
- Coronary microvascular dysfunction (CMD) and obstructive coronary artery disease (CAD) often coexist, potentially causing persistent angina after revascularization.
- Evaluating CMD in patients with recurrent chest pain post-PCI is crucial for understanding treatment limitations.
Purpose of the Study:
- To determine the prevalence and characteristics of CMD in patients experiencing recurrent chest pain after undergoing percutaneous coronary intervention (PCI).
Main Methods:
- A retrospective cross-sectional study involving 102 patients who had previously undergone PCI and presented with recurrent chest pain.
- Coronary angiography and myocardial perfusion imaging (MPI) were used to assess stenosis and myocardial flow reserve (MFR).
- CMD was defined at the vascular level (stenosis <50% with MFR <2.0) and participant level (non-obstructive coronary arteries with vascular-level CMD).
Main Results:
- The prevalence of CMD was 43.1% at the vascular level and 49.0% of patients had coexisting CAD and CMD.
- Patients with CMD exhibited higher BMI, total cholesterol, and LDL-C compared to controls.
- Significantly reduced stress myocardial blood flow (MBF) was observed in CMD patients (1.36±0.43 vs. 2.50±0.70, P<0.01).
- Increased BMI (OR: 1.405) and LDL-C (OR: 3.094) were independently correlated with CMD.
Conclusions:
- Coronary microvascular dysfunction (CMD) is common in post-PCI patients with recurrent angina.
- Elevated BMI and LDL-C are independent predictors of CMD in this patient population.
- These findings underscore the importance of considering and managing CMD in patients with persistent angina post-revascularization.
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 non-obstructive 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.
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