Coronary microvascular dysfunction was an independent predictor of major adverse cardiovascular events at 12 months (HR 2.47; 95% CI 1.68-3.62; p<0.001).
Cohort (n=228)
Does coronary microvascular dysfunction predict major adverse cardiovascular events in patients with angina and non-obstructive coronary artery disease?
Coronary microvascular dysfunction is prevalent in patients with non-obstructive coronary artery disease and independently predicts major adverse cardiovascular events at 12 months.
Hazard Ratio: 2.47 (95% CI 1.68–3.62)
p-value: p=<0.001
Abstract Background Non-obstructive coronary artery disease (NOCAD) is increasingly recognized as a major contributor to ischemic heart disease. Coronary microvascular dysfunction (CMD) plays a critical role in NOCAD, yet its precise pathophysiological mechanisms and prognostic significance remain incompletely understood. This study aimed to assess CMD using invasive and non-invasive measures and evaluate its impact on cardiovascular outcomes. Methods We conducted a prospective study of 228 patients (mean age: 59.3 ± 8.7 years; 62.3% female) with angina and no significant epicardial coronary stenosis (≥50% luminal narrowing). CMD was assessed using coronary flow reserve (CFR) via transthoracic Doppler echocardiography and index of microcirculatory resistance (IMR) during invasive coronary physiology testing. Patients were categorized into CMD-positive (CFR 2.5 or IMR 25 U, n=148) and CMD-negative groups (n=80). Biomarkers, endothelial function (via flow-mediated dilation, FMD), and cardiac magnetic resonance imaging (CMR) with stress perfusion were analyzed. Results CMD-positive patients exhibited lower CFR (1.96 ± 0.43 vs. 2.87 ± 0.36, p0.001), higher IMR (29.7 ± 4.9 vs. 17.3 ± 3.1, p0.001), and reduced FMD (4.8% ± 1.9% vs. 7.2% ± 2.1%, p=0.002). High-sensitivity troponin (hs-TnT) and NT-proBNP were significantly elevated in CMD patients (p0.01). Multivariate logistic regression identified CMD as an independent predictor of major adverse cardiovascular events (MACE) at 12 months (HR=2.47, 95% CI: 1.68–3.62, p0.001). ROC analysis of CFR for predicting MACE yielded an AUC of 0.81 (95% CI: 0.74–0.88, p0.001). Conclusion CMD is prevalent in NOCAD and is associated with impaired endothelial function, elevated biomarkers, and increased MACE risk. CFR and IMR provide robust prognostic utility. Further studies should explore targeted therapies for CMD to improve patient outcomes.
Uzokov et al. (Sat,) conducted a cohort in Non-obstructive coronary artery disease (NOCAD) (n=228). Coronary microvascular dysfunction (CMD) vs. CMD-negative was evaluated on Major adverse cardiovascular events (MACE) at 12 months (HR 2.47, 95% CI 1.68-3.62, p=<0.001). Coronary microvascular dysfunction was an independent predictor of major adverse cardiovascular events at 12 months (HR 2.47; 95% CI 1.68-3.62; p<0.001).