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Publications

Journal Article Ahead of print 4 citations

PubMed: 42442170 DOI: 10.1016/j.jacadv.2026.102946

Impact of Coronary Microvascular Dysfunction on Patient-Reported Symptoms After PCI.

JACC Adv 5(8):102946

Authors: Frédéric Bouisset, Kazumasa Ikeda, Takuya Mizukami, Daniel Munhoz, Jeroen Sonck, Koshiro Sakai, Hitoshi Matsuo, Hirohiko Ando, Brian Ko, Simone Biscaglia, Fernando Rivero, Antonio Maria Leone, Andy Yong, Javier Escaned, Damien Collison, Gianluca Campo, Liyew Desta, Tetsuya Amano, Toshiro Shinke, William F Fearon, Ethan Korngold, Evald Høj Christiansen, Colin Berry, Divaka Perera, Bernard De Bruyne, Nils P Johnson, Carlos Collet

Affiliations

  • Department of Cardiology Toulouse University Hospital, France.
  • Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan.
  • Division of Clinical Pharmacology, Department of Pharmacology, Showa University, Tokyo, Japan; Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
  • Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
  • Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan.
  • Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan.
  • Department of Cardiology, Aichi Medical University, Aichi, Japan.
  • Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia.
  • Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy.
  • Cardiac Department, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain.
  • Center of Excellence in Cardiovascular Sciences, Ospedale Isola Tiberina Gemelli Isola, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy.
  • Concord Repatriation General Hospital, University of Sydney, New South Wales, Australia.
  • Instituto de Investigacion Sanitaria del Hospital Clinico San Carlos and Complutense University, Madrid, Spain.
  • School Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom; NHS Golden Jubilee Hospital, Clydebank, United Kingdom.
  • Department of Cardiology, Karolinska University Hospital, Solna, Stockholm, Sweden.
  • Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University School of Medicine and VA Palo Alto Health Care System, Palo Alto, California, USA.
  • Abbott Vascular.
  • Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark.
  • School of Cardiovascular Medicine and Sciences, St Thomas' Hospital Campus, King's College London, London, United Kingdom.
  • Division of Clinical Pharmacology, Department of Pharmacology, Showa University, Tokyo, Japan.
  • Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USA.
  • Clinical Trial Center, Cardiovascular Research Foundation, New York, New York, USA.

Abstract

BACKGROUND

Coronary microvascular dysfunction (CMD) has been proposed as a mechanism underlying residual angina after percutaneous coronary intervention (PCI).

OBJECTIVES

The objective of the study was to investigate the impact of CMD on symptoms in patients undergoing PCI.

METHODS

Patients with hemodynamically significant coronary artery disease (CAD) (fractional flow reserve ≤0.80) were included. CAD was classified as focal or diffuse using the pull back pressure gradient (PPG) (diffuse CAD defined as PPG <0.62). CMD was defined as microvascular resistance reserve <3.0. The Seattle Angina Questionnaire (SAQ) was administered at baseline and 1 year.

RESULTS

Among 201 patients (mean age 68.5 ± 10.1 years; 71% male), CMD was present in 75 (37.3%), with no difference between focal and diffuse CAD (41% vs 34%; P = 0.35). At baseline, CMD was associated with more severe symptoms without reaching statistical significance (SAQ summary score 64.0 ± 25.3 vs 69.6 ± 21.0; P = 0.09). At 1 year, symptoms were similar between groups (SAQ summary score 87.6 ± 16.0 vs 89.4 ± 16.4; P = 0.47). A significant interaction between PPG and microvascular resistance reserve was observed for residual angina (P for interaction = 0.015); patients with focal CAD and concomitant CMD had the highest burden of residual symptoms.

CONCLUSIONS

CMD is present in approximately one-third of patients undergoing PCI and occurs with similar frequency in focal and diffuse CAD. CMD alone was not associated with residual angina. However, its clinical relevance varied according to the epicardial disease pattern: in focal CAD, concomitant CMD was associated with less symptomatic improvement after PCI, whereas in diffuse CAD, residual symptoms appeared to be driven predominantly by persistent epicardial disease.

MeSH

Signs And Symptoms