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

Figures

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  Figure 1. Study Flowchart CABG = coronary artery bypass grafting; OMT = optimal medical therapy; PCI = percutaneous coronary intervention; SAQ-AF = Seattle Angina Questionnaire Angina Frequency.

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  Figure 2. Correlations Between Pull Back Pressure Gradient and Microvascular Resistance Reserve, Coronary Flow Reserve, Index of Microvascular Resistance, and Index of Microvascular Resistance Corrected Panels A–D show the correlations between PPG and (A) MRR, (B) CFR, (C) IMR, and (D) IMRcorr, respectively. No significant correlation was observed between PPG and MRR. In contrast, PPG showed a significant but weakly negative correlation with CFR and significant but weakly positive correlations with both IMR and IMRcorr.

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  Figure 3. Proportion of CMD Patients in the Entire Cohort and Stratified by CAD Pattern The large pie chart illustrates the overall prevalence of CMD, with 37.3% of patients exhibiting CMD (red) and 62.7% without CMD (dark blue). The smaller pie charts show CMD prevalence by CAD phenotype: 41% in patients with focal CAD and 33.7% in those with diffuse CAD (red). The difference in CMD prevalence between focal and diffuse CAD was not statistically significant (P = 0.35). CAD = coronary artery disease; CMD = coronary microvascular dysfunction.

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  Figure 4. Probability of Underlying CMD Based on 12-Month Functional Status, Stratified by Coronary Artery Disease Pattern This figure illustrates the modeled probability of CMD in relation to residual angina, as measured by the SAQ-AF score. Among patients with focal CAD (blue), lower SAQ-AF scores—reflecting more frequent residual angina—were associated with a higher probability of CMD. In contrast, CMD probability remained relatively stable across the range of SAQ-AF scores in patients with diffuse CAD (red). A significant interaction was observed between CAD pattern and SAQ score in predicting CMD (P for interaction = 0.015). Shaded areas indicate 95% CIs. Abbreviations as in Figures 1 and 3.

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  Central Illustration. Impact of Coronary Microvascular Dysfunction on Patient-Reported Symptoms in Patients Undergoing PCI Coronary microvascular dysfunction (CMD), defined as MRR <3.0, was present in approximately one-third of patients undergoing PCI with comprehensive physiological assessment and was similarly prevalent in focal and diffuse epicardial disease. At baseline, CMD was associated with greater symptom burden as assessed by SAQ-7. However, CMD alone did not uniformly predict residual angina after PCI. In focal coronary artery disease, CMD was associated with more residual angina, suggesting that microvascular dysfunction may limit the symptomatic benefit of successful epicardial revascularization. In contrast, in diffuse coronary artery disease, residual symptoms appeared to be mainly driven by persistent epicardial disease rather than CMD. FFR = fractional flow reserve; MRR = microvascular resistance reserve; PCI = percutaneous coronary intervention; PPG = pull back pressure gradient; SAQ-AF = Seattle Angina Questionnaire Angina Frequency.