Association between prior stenting and coronary vasomotor and microvascular function in patients with angina and nonobstructive coronary arteries

BACKGROUND/INTRODUCTION Interventional diagnostic procedures (IDPs) are essential for characterizing coronary vasomotor and microvascular physiology in patients with angina and nonobstructive coronary arteries (ANOCA). Although IDPs effectively identify coronary spasm and microvascular dysfunction (CMD), the independent impact of prior percutaneous coronary intervention (PCI) on these functional phenotypes remains poorly defined in the ANOCA population. Purpose We aimed to clarify the impact of prior PCI history on epicardial coronary spasm, microvascular spasm (MVS) and CMD phenotypes. Methods This sub-analysis of the prospective, multicenter J-CMD Registry included 674 ANOCA patients undergoing comprehensive IDPs, comprising acetylcholine provocation and bolus thermodilution-based physiological assessment. We compared the prevalence of epicardial spasm, microvascular spasm (MVS), and CMD between patients with and without prior stenting. MVS was defined as induced ischemic symptom and electrocardiographic change without angiographic during SPT. CMD was defined as coronary flow reserve <2.5. Propensity score matching was employed to adjust for baseline clinical disparities. Results Prior stenting was present in 10.1% (n=68) of the cohort. In the unadjusted analysis, rates of positive spasm provocation (48.5% vs. 48.5%, P=0.10) and MVS (17.6% vs. 20.5%, P=0.70) were comparable, whereas CMD was significantly more prevalent in stented patients (38.2% vs. 26.1%, P=0.04). However, after propensity score matching (n=56 pairs), this association was eliminated; no significant differences were observed in the prevalence of positive epicardial spasm provocation, MVS, or CMD between the groups. Conclusions In this prospective nationwide multicenter registry, prior coronary stenting was not independently associated with functional coronary abnormalities. The higher crude prevalence of CMD among stented patients likely reflects a burden of clinical comorbidities rather than a direct sequela of stenting. These findings suggest that stenting per se does not predispose patients to subsequent coronary vasomotor or microvascular dysfunction.