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Coronary microvascular dysfunction in post-PCI target vessels: a systematic review and meta-analysis of prevalence
Yunze Li1,2, Jinlan Duan3, Hongxu Liu2
1Graduate School, Beijing University of Chinese Medicine, Beijing, China.
Background:
Coronary microvascular dysfunction (CMD) in post-percutaneous coronary intervention (PCI) target vessels is increasingly recognized as a critical determinant of adverse cardiovascular outcomes, yet its prevalence and prognostic implications remain poorly characterized. We conducted a systematic review and meta-analysis to determine the prevalence of CMD in post-PCI target vessels and its associated clinical outcomes.
Methods:
We conducted a systematic review and meta-analysis of observational studies using quantitative coronary physiological assessments to evaluate CMD in post-PCI target vessels. Databases (PubMed, Embase, Web of Science) were searched from inception to January 2025. The pooled Prevalence, multivariable-adjusted hazard ratio (HR) and 95% confidence interval (CI) for clinical outcomes were calculated using random-effects models.
Results:
A total of 21 observational studies involving 6,632 patients were included. The pooled prevalence of CMD in post-PCI target vessels was 41.66% (95% CI: 34.18%-49.34%). Subgroup analyses revealed numerical variations in CMD prevalence across assessment methods, sex, clinical diagnoses, and target vessels, though intergroup differences did not reach statistical significance (all P > 0.05). The pooled prevalence of CMD was numerically higher in females (46.22% vs. 36.73% in males), patients with acute coronary syndrome (42.37% vs. 36.04% in chronic coronary syndrome), and those assessed via non-wire-based methods (44.72% vs. 35.65% in wire-based methods). CMD prevalence was comparable across target vessels (left anterior descending artery: 37.34%, left circumflex artery: 38.50%, right coronary artery: 39.09%). Patients with post-PCI thrombolysis in myocardial infarction (TIMI) flow grade ≤2 exhibited higher CMD prevalence than those with TIMI flow grade 3, with a statistically significant difference (75.36% vs. 37.26%, P = 0.0012). CMD in post-PCI target vessels was independently associated with a 3.10-fold increased risk of major adverse cardiovascular events (95% CI: 2.06-4.67) and a 4.66-fold risk of cardiac death or heart failure readmission (95% CI: 3.13-6.93).
Conclusion:
CMD in post-PCI target vessels is prevalent (approximately 40%) and independently associated with a elevated risk of adverse cardiovascular outcomes. Standardized diagnostic criteria and targeted interventions are urgently needed to improve outcomes in this population.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/, PROSPERO CRD42025637496.
Insights
Coronary microvascular dysfunction (CMD) after percutaneous coronary intervention (PCI) affects nearly 40% of patients and significantly increases the risk of major adverse cardiovascular events and cardiac death.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Coronary microvascular dysfunction (CMD) in vessels targeted by percutaneous coronary intervention (PCI) is a recognized contributor to adverse cardiovascular events.
- The precise prevalence and prognostic impact of post-PCI CMD remain incompletely understood.
Purpose of the Study:
- To systematically review and meta-analyze observational studies to determine the prevalence of CMD in post-PCI target vessels.
- To assess the association between post-PCI CMD and clinical outcomes.
Main Methods:
- A systematic literature search of PubMed, Embase, and Web of Science was conducted up to January 2025.
- Quantitative coronary physiological assessments from 21 observational studies (6,632 patients) were analyzed using random-effects models.
- Prevalence and multivariable-adjusted hazard ratios (HR) for clinical outcomes were calculated.
Main Results:
- The pooled prevalence of CMD in post-PCI target vessels was 41.66%.
- Higher CMD prevalence was observed in females, patients with acute coronary syndrome, and those assessed via non-wire-based methods.
- CMD was independently associated with a 3.10-fold increased risk of major adverse cardiovascular events and a 4.66-fold risk of cardiac death or heart failure readmission.
Conclusions:
- Post-PCI CMD is prevalent, affecting approximately 40% of patients.
- CMD is an independent predictor of adverse cardiovascular outcomes, including major adverse cardiovascular events and cardiac death.
- Standardized diagnostic criteria and targeted interventions are necessary to mitigate risks associated with post-PCI CMD.
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