Primary versus iatrogenic (post-PCI) coronary microvascular dysfunction: a wire-based multimodal comparison

• Published in: Open heart Vol. 10; no. 2; p. e002437
• Main Authors: Hasdemir, Hakan, Taş, Ahmet, Cevik, Erdem, Alan, Yaren, Broyd, Christopher J, Ozcan, Alp, Sonsoz, Mehmet R, Kara, Ilke, Demirtakan, Zeynep G, Parker, Kim, Perera, Divaka, Umman, Sabahattin, Sezer, Murat
• Format: Journal Article
• Language: English
• Published: London British Cardiovascular Society 27.11.2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Angioplasty; Cardiovascular disease; Clinical trials; Coronary Artery Disease; Coronary vessels; Flow velocity; Hemodynamics; Iatrogenesis; Ischemia; microvascular angina; percutaneous coronary intervention; Software; Statistical analysis; Variables; Variance analysis; Vein & artery diseases; Istanbul Turkey; United States > US; Turkey
• ISSN: 2053-3624; 2398-595X; 2053-3624
• DOI: 10.1136/openhrt-2023-002437

BackgroundAlthough there are studies examining each one separately, there are no data in the literature comparing the magnitudes of the iatrogenic, percutaneous coronary intervention (PCI)-induced, microvascular dysfunction (Type-4 CMD) and coronary microvascular dysfunction (CMD) in the setting of ischaemia in non-obstructed coronary arteries (INOCA) (Type-1 CMD).ObjectivesWe aimed to compare the characteristics of Type-1 and Type-4 CMD subtypes using coronary haemodynamic (resistance and flow-related parameters), thermodynamic (wave energy-related parameters) and hyperemic ECG changes.MethodsCoronary flow reserve (CFR) value of <2.5 was defined as CMD in both groups. Wire-based multimodal perfusion markers were comparatively analysed in 35 patients (21 INOCA/CMD and 14 CCS/PCI) enrolled in NCT05471739 study.ResultsBoth groups had comparably blunted CFR values per definition (2.03±0.22 vs 2.11±0.37; p: 0.518) and similar hyperemic ST shift in intracoronary ECG (0.16±0.09 vs 0.18±0.07 mV; p: 0.537). While the Type-1 CMD was characterised with impaired hyperemic blood flow acceleration (46.52+12.83 vs 68.20+28.63 cm/s; p: 0.017) and attenuated diastolic microvascular decompression wave magnitudes (p=0.042) with higher hyperemic microvascular resistance (p<0.001), Type-4 CMD had blunted CFR mainly due to higher baseline flow velocity due to post-occlusive reactive hyperemia (33.6±13.7 vs 22.24±5.3 cm/s; p=0.003).ConclusionsThe perturbations in the microvascular milieu seen in CMD in INOCA setting (Type-1 CMD) seem to be more prominent than that of seen following elective PCI (Type-4 CMD), although resulting reversible ischaemia is equally severe in the downstream myocardium.