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Coronary Flow Reserve Measured by Myocardial Perfusion Imaging in Patients Following Percutaneous Coronary
Jingjing Liu1,2, Jian Zhang2, Wenhua Lin2
1Department of Cardiology, Clinical School of Cardiovascular Disease, Tianjin Medical University, Tianjin, China.
Insights
Coronary microvascular dysfunction (CMD) is common after percutaneous coronary intervention (PCI), affecting nearly half of patients. Acute myocardial infarction, type 2 diabetes, and hyperlipidemia are key predictors of CMD post-PCI.
Area of Science:
- Cardiology
- Vascular Biology
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) patients may face adverse outcomes despite complete revascularization, possibly due to coronary microvascular dysfunction (CMD).
- Coronary flow reserve (CFR) assesses both epicardial and microvascular function; reduced CFR post-revascularization indicates CMD.
Purpose of the Study:
- To measure CFR in patients after percutaneous coronary intervention (PCI) for complete revascularization using myocardial perfusion imaging (MPI).
- To determine the prevalence of CMD and identify associated risk factors in this patient cohort.
Main Methods:
- Collected clinical data from 301 patients undergoing PCI between March 2020 and March 2022.
- Assessed CFR using MPI, with CMD defined as CFR < 2.0.
- Utilized logistic regression to analyze factors associated with CMD.
Main Results:
- The incidence of CMD was 43.9% (132/301) post-PCI.
- Multivariate analysis identified acute myocardial infarction (AMI), Type 2 Diabetes Mellitus (T2DM), and hyperlipidemia as independent predictors of CMD.
- Univariate analysis also linked clinical presentation, prior myocardial infarction, ACEI/ARB use, and stent number to CMD.
Conclusions:
- CMD is prevalent after PCI, especially in patients with AMI, T2DM, and hyperlipidemia.
- Post-PCI CFR assessment is essential for identifying CMD.
- Developing strategies to prevent peri-procedural CMD is warranted.
Background:
Despite achieving complete revascularization, patients with coronary artery disease (CAD) may experience adverse outcomes, potentially attributable to coronary microvascular dysfunction (CMD). Coronary flow reserve (CFR), which integrates both epicardial and microvascular coronary function, and a reduced CFR following complete revascularization indicates the presence of CMD.
Aims:
This study aimed to measure CFR in patients who underwent percutaneous coronary intervention (PCI) for complete revascularization using myocardial perfusion imaging (MPI) and analyzed the prevalence of CMD and its correlation factors.
Methods:
The clinical data of patients admitted to TEDA International Cardiovascular Hospital between March 2020 and March 2022 were collected. CFR was assessed using MPI. Coronary angiography confirmed successful PCI-defined revascularization. CMD was defined as CFR < 2.0 in any of the three coronary arteries. Logistic regression model was established to analyze the factors associated with CMD.
Results:
A total of 301 patients were included. Among the enrolled patients, the incidence of CMD was 43.9% (132/301). Univariate analysis identified clinical presentation, prior myocardial infarction, Type 2 diabetes mellitus (T2DM), hyperlipidemia, the use of angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) and the number of stents implanted as associated with CMD. Multivariate analysis identified acute myocardial infarction (AMI) (OR = 4.187 95% CI:1.291-13.586), T2DM (OR = 1.878 95% CI: 1.120-3.149) and hyperlipidemia (OR = 1.970 95% CI:1.177-3.299) as independent predictors of CMD.
Conclusion:
CMD is prevalent following PCI, particularly in patients presenting with AMI or having comorbidities like T2DM and hyperlipidemia. Post-PCI CFR assessment is crucial, and strategies to prevent CMD in the peri-procedural period warrant consideration.
