Key result
Increased microvascular resistance post-PCI is linked to a ~260% higher risk of target vessel failure.
Why the study?
Determinants of relative changes in microvascular resistance post-PCI and their association with target vessel failure had not been previously investigated.
Does an increase in microvascular resistance following PCI predict target vessel failure in patients undergoing PCI?
Observational (n=828)
Yes
Does an increase in microvascular resistance following PCI predict target vessel failure in patients undergoing PCI?
An increase in microvascular resistance following PCI is associated with less severe baseline hemodynamic lesions and a significantly higher risk of subsequent target vessel failure.
May flag higher-risk PCI patients for closer follow-up; leaves open whether microvascular resistance is a modifiable target.
BACKGROUND: Microvascular resistance (MR) has prognostic value in acute and chronic coronary syndromes following percutaneous coronary intervention (PCI), however anatomic and physiologic determinants of the relative changes of MR and its association to target vessel failure (TVF) has not been investigated previously. This study aims to evaluate the association between changes in MR and TVF. METHODS: This is a sub-study of the Inclusive Invasive Physiological Assessment in Angina Syndromes (ILIAS) registry which is a global multi-centre initiative pooling lesion-level coronary pressure and flow data. RESULTS: Paired pre-post PCI haemodynamic data were available in n = 295 vessels out of n = 828 PCI treated patients and of these paired data on MR was present in n = 155 vessels. Vessels were divided according to increase vs. decrease % in microvascular resistance following PCI (ΔMR % ≤ 0 vs. ΔMR > 0%). Decreased microvascular resistance ΔMR % ≤ 0 occurred in vessels with lower pre-PCI fractional flow reserve (0.67 ± 0.15 vs. 0.72 ± 0.09 p = 0.051), coronary flow reserve (1.9 ± 0.8 vs. 2.6 ± 1.8 p < 0.0001) and higher hyperemic microvascular resistance (2.76 ± 1.3 vs. 1.62 ± 0.74 p = 0.001) and index of microvascular resistance (24.4 IQ (13.8) vs. 15. 8 IQ (13.2) p = 0.004). There was no difference in angiographic parameters between ΔMR % ≤ 0 vs. ΔMR > 0%. In a cox regression model ΔMR % > 0 was associated with increased rate of TVF (hazard ratio 95% CI 3.6 [1.2; 10.3] p = 0.018). CONCLUSION: Increased MR post-PCI was associated with lesions of less severe hemodynamic influence at baseline and higher rates of TVF at follow-up.
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Eftekhari et al. (2023) conducted an observational in Acute and chronic coronary syndromes (n=828). Increase in microvascular resistance post-PCI (ΔMR > 0%) vs. Decrease or no change in microvascular resistance (ΔMR % ≤ 0) was evaluated on Target vessel failure (TVF) (HR 3.6, 95% CI 1.2-10.3, p=0.018). An increase in microvascular resistance following PCI was associated with an increased rate of target vessel failure compared to a decrease or no change (HR 3.6; 95% CI 1.2-10.3; p=0.018).
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