When Does Coronary Microvascular Dysfunction Matter After PCI?

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: Coronary microvascular dysfunction and residual angina after PCI. Intervention: Coronary microvascular dysfunction (CMD) vs. Absence of CMD. Primary outcome: Residual angina at 1 year.

Q: What does this research mean for the field?

Coronary microvascular dysfunction is associated with greater residual angina at 1 year following PCI in patients with focal epicardial disease, but not in those with diffuse disease. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jinnette Dawn Abbott; Sugi Min

doi:10.1016/j.jacadv.2026.102961

July 14, 2026JACC AdvancesOpen Access

When Does Coronary Microvascular Dysfunction Matter After PCI?

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Graphical abstract published by JACC Advances — Graphical abstract · Published by JACC Advances · CC BY-NC-ND

Why the study?

Does the baseline pattern of epicardial disease influence the relationship between coronary microvascular dysfunction and residual angina after PCI?

Key Points

To assess the prevalence of coronary microvascular dysfunction and determine its relationship with residual angina across focal versus diffuse epicardial disease patterns following percutaneous coronary intervention.
Conducted a predefined subanalysis of the prospective multicenter Pullback Pressure Gradient (PPG) Global Registry in patients undergoing percutaneous coronary intervention for hemodynamically significant epicardial disease.
Categorized epicardial physiological disease patterns dichotomously as focal or diffuse using established PPG thresholds and evaluated coronary microvascular dysfunction using microvascular resistance reserve.
Coronary microvascular dysfunction occurred in more than one-third of patients, presenting with similar frequency across focal and diffuse epicardial disease phenotypes.
Coronary microvascular dysfunction was associated with greater residual angina at 1 year among patients with focal disease, whereas symptom burden in diffuse disease was independent of microvascular status.

Structured PICO

Does the baseline pattern of epicardial disease influence the relationship between coronary microvascular dysfunction and residual angina after PCI?

P

Population

Patients undergoing percutaneous coronary intervention (PCI) for hemodynamically significant epicardial disease from the prospective multicenter Pullback Pressure Gradient (PPG) Global Registry

E

Exposure

Integration of epicardial physiological patterns characterized by Pullback Pressure Gradient (PPG) with microvascular assessment using microvascular resistance reserve (MRR)

O

Outcome

Residual angina/symptoms at 1 yearpatient reported

Limitations

Microvascular assessment was performed at operator discretion, introducing the possibility of selection bias.
Symptom assessment at baseline and 1-year limits understanding of the temporal evolution of symptom relief after PCI.
Vasospasm represents another important contributor to residual angina that was not evaluated in this analysis.
Microvascular assessment was performed at operator discretion, resulting in analysis of a relatively small subgroup and introducing selection bias
Symptom assessment limited to baseline and 1-year, missing the temporal evolution of symptom relief during the early postprocedural period
Vasospasm, an important contributor to residual angina, was not evaluated

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Implication

The physiological pattern of epicardial disease (focal vs. diffuse) contextualizes when coronary microvascular dysfunction is most clinically relevant to residual angina after PCI.

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Cite This Study

Abbott et al. (2026) conducted an editorial in Coronary microvascular dysfunction and residual angina after PCI. Coronary microvascular dysfunction (CMD) vs. Absence of CMD was evaluated on Residual angina at 1 year.

synapsesocial.com/papers/6ac198fed2b33a8deea23d69 https://doi.org/10.1016/j.jacadv.2026.102961

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When Does Coronary Microvascular Dysfunction Matter After PCI?

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

When Does Coronary Microvascular Dysfunction Matter After PCI?

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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