September 1, 2019Circulation Cardiovascular InterventionsOpen Access

Prognostic Value of Coronary Microvascular Function Measured Immediately After Percutaneous Coronary Intervention in Stable Coronary Artery Disease

Q: What are the key findings of this study?

High index of microcirculatory resistance (IMR≥25) post-PCI predicted a 56% increased risk of major adverse cardiac events compared to low IMR in stable coronary artery disease patients (HR 1.56).

Q: What does this research mean for the field?

High index of microcirculatory resistance (IMR≥25) post-PCI predicts a 56% increased risk of major adverse cardiac events compared to low IMR in stable coronary artery disease patients (HR 1.56). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

High IMR post-PCI predicts ~56% higher MACE risk versus low IMR in stable CAD.

HR 1.56

Why the study?

The prognostic impact of coronary microvascular dysfunction after PCI remained unclear in patients with stable coronary artery disease.

Does impaired microvascular function (high IMR) measured immediately after PCI predict major adverse cardiac events in patients with stable coronary artery disease?

Population

572 patients with stable coronary artery disease undergoing PCI from 8 centers in 4 countries

Comparison

High IMR (≥25) vs low IMR immediately post-PCI

Design

Multicenter observational cohort study

Follow-up

Median 4.0 years

Authors

TNTakeshi NishiShowa University TMTadashi MuraiInterventional Cardiology GCGiovanni CiccarelliOspedale Monaldi

Discussion

Member takes

Implication

Post-PCI IMR may refine risk stratification in stable CAD; leaves open whether microvascular-targeted therapies improve outcomes.

Structured PICO

Does impaired microvascular function (high IMR) measured immediately after PCI predict major adverse cardiac events in patients with stable coronary artery disease?

Population

572 patients with stable coronary artery disease who underwent elective and successful percutaneous coronary intervention (PCI), mean age 67, 82% male, multinational (4 countries). Excluded: required immediate revascularization, acute coronary syndrome, previous MI in the target vessel, previous bypass graft to the target vessel, recent MI.

Intervention

Impaired microvascular function, defined as a high index of microcirculatory resistance (IMR ≥25) measured immediately after percutaneous coronary intervention using a pressure-temperature sensor guide wire.

Comparator

Preserved microvascular function, defined as a low index of microcirculatory resistance (IMR <25) measured immediately after percutaneous coronary intervention.

Outcome

Major adverse cardiac events (MACE), defined as a composite of all-cause mortality, any myocardial infarction (MI), and target vessel revascularization at a median follow-up of 4.0 years.composite

An elevated index of microcirculatory resistance (IMR ≥25) measured immediately after PCI in stable coronary artery disease is an independent predictor of long-term major adverse cardiac events.

Limitations

neither the patients nor the physicians were blinded to the physiological values
no data regarding the total number of PCIs performed at each institution during enrollment
periprocedural MI was a key component of the primary end point, and the prognostic importance of such troponin elevation remains controversial
IMR did not completely correspond to periprocedural MI one-to-one
pre-PCI IMRtrue was not available in many patients, limiting investigation of the change in IMR before and after PCI

Cite This Study

Nishi et al. (2019) studied this question. High index of microcirculatory resistance (IMR≥25) post-PCI predicted a 56% increased risk of major adverse cardiac events compared to low IMR in stable coronary artery disease patients (HR 1.56).

synapsesocial.com/papers/696bdcb272d15f53efa1e691 https://doi.org/10.1161/circinterventions.119.007889

Topics

Percutaneous coronary intervention Coronary artery disease Chronic total occlusion PCI

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Prognostic Value of Coronary Microvascular Function Measured Immediately After Percutaneous Coronary Intervention in Stable Coronary Artery Disease

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Topics

Prognostic Value of Coronary Microvascular Function Measured Immediately After Percutaneous Coronary Intervention in Stable Coronary Artery Disease

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

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Topics

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