Association of microvascular dysfunction with clinical outcomes in patients with non-flow limiting fractional flow reserve after percutaneous coronary intervention

International Journal of Cardiology: Heart & Vasculature

卷:35

Tadashi Murai¹  Tsunekazu Kakuta²  Tetsuya Amano³  Katsuhisa Waseda⁴  Atsushi Hirohata⁵  William F. Fearon⁵  Martin K.C. Ng⁶  Andy S.C. Yong⁷  Takeshi Nishi⁸  Emanuele Barbato⁹ 

[1] Department of Cardiology, Kawasaki Medical School, Okayama, Japan;

[2] Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia;

[3] Sydney Medical School, The University of Sydney, Sydney, Australia;

[4] Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Japan;

[5] Department of Cardiology, Aichi Medical University, Aichi, Japan;

[6] Department of Cardiology, Concord Hospital, Sydney, Australia;

[7] Department of Cardiovascular Medicine, Sakakibara Heart Institute of Okayama, Okayama, Japan;

[8] Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, CA, United States;

关键词: Microvascular dysfunction;    Fractional flow reserve;    The index of microcirculatory resistance;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: We sought to investigate prognostic implication of microvascular dysfunction as assessed by the index of microcirculatory index (IMR) in patients without residual obstructive CAD with non-flow limiting fractional flow reserve (FFR) (>0.80) following percutaneous coronary intervention (PCI). Methods: A total of 570 patients who had both post-PCI FFR and IMR values were included in the present analysis; of these, 65 patients had FFR ≤ 0.80 and 505 had FFR > 0.80. Of the 505 patients with FFR > 0.80, 137 had high IMR and 368 had low IMR. The primary outcome of the present analysis is a composite of all-cause death, spontaneous myocardial infarction, or target-vessel revascularization. Impaired microvascular function was defined as IMR ≥ 25 (high IMR). Results: During a median follow-up duration of 4.0 years, those with FFR > 0.80 and low IMR demonstrated lower rate or primary outcome event than those with FFR ≤ 0.80 (hazard ratio 0.49 [95% confidence interval 0.27–0.92], p = 0.026) and those with FFR > 0.80 and high IMR (hazard ratio 1.60 [0.99–2.16], p = 0.056). The patients with FFR > 0.80 and IMR ≥ 25 had similar rate of primary outcome event compared with those with FFR ≤ 0.80 (p = 0.49). Conclusion: Microvascular dysfunction following PCI is not rare and is associated with adverse events even in the setting of a non-flow limiting FFR; these results suggest that when performing coronary physiologic assessment following PCI, interrogating not only the epicardial vessel, but also the microvasculature is useful for the risk stratification in patients undergoing PCI.

【 授权许可】

Unknown