Peripheral microvascular function and long-term cardiovascular outcomes after percutaneous coronary intervention in patients with obstructive coronary artery disease.

BACKGROUND

Despite advances in percutaneous coronary intervention (PCI), patients with obstructive coronary artery disease (CAD) continue to experience recurrent ischemic symptoms and adverse cardiovascular events. Skin post-occlusive reactive hyperemia (PORH) is a noninvasive measure of systemic microvascular function that may add prognostic information beyond epicardial coronary anatomy, but its relation to long-term cardiovascular outcomes after PCI has not been well defined.

METHODS

We performed a retrospective analysis of a prospectively established CAD registry that included 197 patients with obstructive CAD who underwent PCI and baseline assessment of the skin PORH response. Long-term composite cardiovascular outcomes were evaluated over follow-up of up to 5 years using Kaplan-Meier methods and Cox proportional hazards regression, with propensity score matching used as a sensitivity analysis.

RESULTS

The median age of the cohort was 66 years, and 84.8% of patients were male. Compared with those in the higher PORH group, patients with a lower PORH index had more cardiometabolic comorbidities and experienced significantly higher rates of long-term composite cardiovascular events. In multivariable Cox analysis, a higher PORH index was independently associated with a lower risk of composite cardiovascular events (adjusted hazard ratio, 0.422; 95% confidence interval, 0.198-0.898), and this inverse association was preserved in the propensity score-matched cohort.

CONCLUSIONS

In patients with obstructive CAD undergoing PCI, impaired skin PORH was independently associated with an increased risk of long-term composite cardiovascular events. These findings support a potential role for skin microvascular assessment in cardiovascular risk stratification, and warrant confirmation in larger prospective studies.