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Updated: Jul 15, 2026
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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Impact of Coronary Microvascular Dysfunction on Patient-Reported Symptoms After PCI.
Frédéric Bouisset1, Kazumasa Ikeda2, Takuya Mizukami3
1Department of Cardiology Toulouse University Hospital, France.
JACC. Advances
|July 13, 2026
Summary
Coronary microvascular dysfunction (CMD) affects about one-third of patients after percutaneous coronary intervention (PCI). While not a direct cause of angina, CMD significantly impacts symptoms, especially when combined with focal coronary artery disease (CAD).
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Coronary microvascular dysfunction (CMD) is a potential cause of persistent angina after percutaneous coronary intervention (PCI).
- Understanding the role of CMD in post-PCI symptoms is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the impact of CMD on symptom burden in patients undergoing PCI.
- To determine if CMD influences residual angina based on the pattern of epicardial coronary artery disease (CAD).
Main Methods:
- Included patients with significant CAD (FFR ≤0.80).
- Classified CAD as focal or diffuse using pull back pressure gradient (PPG).
- Defined CMD (microvascular resistance reserve <3.0) and assessed symptoms using the Seattle Angina Questionnaire (SAQ) at baseline and 1 year.
Main Results:
- CMD was present in 37.3% of patients, with similar prevalence in focal and diffuse CAD.
- CMD alone was not significantly associated with residual angina at baseline or 1 year.
- A significant interaction showed that focal CAD with concomitant CMD led to the highest burden of residual symptoms.
Conclusions:
- CMD is common after PCI, occurring in both focal and diffuse CAD.
- The clinical significance of CMD on residual angina depends on the epicardial CAD pattern.
- Focal CAD with CMD is associated with less symptomatic improvement post-PCI, while diffuse CAD symptoms are driven by persistent epicardial disease.
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