Coronary microvascular dysfunction assessment: A comparative analysis of procedural aspects

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Coronary microvascular dysfunction (CMD) assessment adoption is hindered by its invasive nature, procedure duration, and contrast/radiation exposure concerns.
• This study compares procedural aspects of invasive CMD assessment against diagnostic left heart catheterization (DLHC).

Purpose of the Study:

• To evaluate the safety and procedural differences between invasive coronary microvascular dysfunction assessment and diagnostic left heart catheterization.
• To determine if invasive CMD assessment leads to significantly increased procedure time, contrast, or radiation exposure.

Main Methods:

• A comparative analysis of 227 patients undergoing CMD assessment versus 1592 patients undergoing DLHC.
• Propensity-score matching was used to compare primary outcomes: fluoroscopy time and total contrast use.
• Data were collected from August 2021 to November 2023.

Main Results:

• Patients undergoing CMD assessment were more likely to be female and have hypertension, stroke, or myocardial infarction history.
• CMD assessment demonstrated safety with no reported adverse outcomes.
• Slightly higher median contrast exposure (10 mL more) and longer fluoroscopy time (2 min longer) were observed in CMD assessment, but radiation dose and overall procedure time were similar.

Conclusions:

• Invasive CMD assessment is safe and feasible, comparable to DLHC.
• The minor increases in contrast use and fluoroscopy time associated with CMD assessment are clinically insignificant.
• These results support the broader adoption of invasive CMD assessment in clinical practice.