Coronary Flow Reserve Measured by Myocardial Perfusion Imaging in Patients Following Percutaneous Coronary Intervention.

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.