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Coronary Microcirculatory Function Indicated by Coronary Angiography-Derived Index of Microvascular Resistance in
1Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730 Beijing, China.
Insights
Rotational atherectomy (RA) significantly worsens coronary microcirculation, indicated by increased coronary angiography-derived index of microvascular resistance (caIMR). Baseline microvascular dysfunction predicts worse outcomes after RA, highlighting the need for careful patient selection and management.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Limited data exist on the impact of rotational atherectomy (RA) on coronary microcirculation.
- Coronary microcirculation function is crucial for myocardial perfusion and outcomes.
Purpose of the Study:
- To evaluate changes in coronary microcirculation function, assessed by coronary angiography-derived index of microvascular resistance (caIMR), following RA.
- To identify predictors of adverse outcomes after RA.
Main Methods:
- Retrospective analysis of 155 RA procedures (January 2013 - December 2021).
- Coronary microcirculation function assessed using caIMR measured by the FlashAngio system before and after RA.
- Primary outcome included post-RA Thrombolysis In Myocardial Infarction (TIMI) flow grade < 3, myocardial injury, procedure-related myocardial infarction, and cardiac death.
Main Results:
- Post-RA caIMR was significantly higher than pre-RA caIMR (16.0 ± 7.0 vs. 14.5 ± 7.5, p=0.029).
- Patients with post-RA caIMR ≥ 25 represented 12% of those with pre-RA caIMR ≥ 25.
- Higher pre-RA caIMR (≥ 25) and longer maximum RA time per pass were independent predictors of adverse outcomes.
Conclusions:
- RA leads to significant impairment of coronary microcirculation function, evidenced by increased post-procedural caIMR.
- Pre-existing coronary microvascular dysfunction is associated with a higher likelihood of developing post-RA TIMI flow grade < 3.
- Patients with higher baseline caIMR values are at increased risk for worse outcomes following RA.
Background:
There are scarce published data reporting the effect of rotational atherectomy (RA) on coronary microcirculation function.
Objectives:
We aimed to evaluate coronary microcirculation function indicated by the coronary angiography-derived index of microvascular resistance (caIMR) in patients undergoing RA.
Methods:
RA procedures between January 2013 and December 2021 were retrospectively analyzed. We investigated coronary microcirculation function indicated by caIMR as well as peri-procedural adverse events among the study population. All caIMR measurements were performed using a FlashAngio system. The primary outcome was a composite of post-RA thrombolysis in myocardial infarction (TIMI) flow grade 3 in the target vessel, myocardial injury, procedure-related myocardial infarction, and cardiac death during hospitalization.
Results:
A total of 155 RA procedures were analyzed. The post-RA caIMRs were significantly higher than pre-RA caIMRs in the target vessels (16.0 7.0 vs. 14.5 7.5, p = 0.029). Patients with post-RA caIMR 25 accounted for nearly 12% of those with pre-RA caIMR 25. Patients with post-RA thrombolysis in myocardial infarction (TIMI) flow grade 3 had a significantly higher pre-RA caIMR (23.5 10.2 vs. 13.7 6.6, p = 0.005), and the proportion of patients with pre-RA caIMR 25 in the group with TIMI flow grade 3 was greater (61.5% vs. 38.5%, p 0.001) than that in the group with TIMI flow grade of 3. Maximum RA time of each pass (odds ratio: 1.127, 95% confidence interval: 1.025-1.239, p = 0.014) and pre-RA caIMR 25 (odds ratio: 3.254, 95% confidence interval: 1.054-10.048, p = 0.040) were identified to be the independent predictors of the primary outcome for patients who underwent RA.
Conclusions:
There were significant changes in the coronary microcirculation function of the target vessels after receiving RA as indicated by increased post-RA caIMR compared to pre-RA caIMR. Patients with baseline coronary microcirculatory dysfunction were more likely to have post-RA TIMI flow grade 3, whereas those with pre-RA caIMR 25 experienced worse outcomes.
