Prognostic effect of invasively diagnosed coronary microvascular dysfunction: A systematic review and META-analysis.
The association of epicardial obstructive coronary artery disease with major adverse cardiovascular events (MACE) is established; however, accumulating evidence emphasizes the significant role of coronary microvascular dysfunction (CMD). The aim of this meta-analysis is to summarize the available evidence on the prognostic effect of CMD in cardiovascular outcomes and mortality.
Systematic literature search in MEDLINE/PubMed and Scopus was conducted to identify studies comparing the prognosis of CMD vs non-CMD using coronary flow reserve (CFR) and/or index of microcirculatory resistance (IMR) invasive indices. A meta-analysis to calculate pooled risk ratios (RR) was performed along with sensitivity and meta-regression analyses.
Thirty-one studies were included (n = 13,016, weighted mean age 58 years, males 57%, left ventricular ejection fraction 58%, CFR 2.6, IMR 24.4, CMD 33%). Meta-analysis of 24 studies (n = 8294) indicated a pooled RR for MACE of 2.55 (2.11, 3.10) for CMD vs non-CMD comparison. Consistent findings were observed for all-cause [1.88 (1.52, 2.33)] and cardiovascular mortality [2.76 (2.02, 3.76)], myocardial infarction [2.18 (1.56, 3.05)], revascularization [1.67 (1.06, 2.64)], heart failure hospitalization [3.46 (1.90, 6.30)], and stroke risk [1.85 (1.26, 2.71)]. The CFR and IMR-based analyses provided similar findings. Worse outcomes were observed in acute coronary syndrome patients and in those with the structural CMD endotype (abnormal CFR/abnormal IMR).
Invasively diagnosed CMD is associated with a 2.5-fold increase in MACE and a 3-fold increase in cardiovascular mortality. This finding highlights the importance of a more comprehensive assessment of coronary vasculature, including both the macro- and the microcirculation.
Systematic literature search in MEDLINE/PubMed and Scopus was conducted to identify studies comparing the prognosis of CMD vs non-CMD using coronary flow reserve (CFR) and/or index of microcirculatory resistance (IMR) invasive indices. A meta-analysis to calculate pooled risk ratios (RR) was performed along with sensitivity and meta-regression analyses.
Thirty-one studies were included (n = 13,016, weighted mean age 58 years, males 57%, left ventricular ejection fraction 58%, CFR 2.6, IMR 24.4, CMD 33%). Meta-analysis of 24 studies (n = 8294) indicated a pooled RR for MACE of 2.55 (2.11, 3.10) for CMD vs non-CMD comparison. Consistent findings were observed for all-cause [1.88 (1.52, 2.33)] and cardiovascular mortality [2.76 (2.02, 3.76)], myocardial infarction [2.18 (1.56, 3.05)], revascularization [1.67 (1.06, 2.64)], heart failure hospitalization [3.46 (1.90, 6.30)], and stroke risk [1.85 (1.26, 2.71)]. The CFR and IMR-based analyses provided similar findings. Worse outcomes were observed in acute coronary syndrome patients and in those with the structural CMD endotype (abnormal CFR/abnormal IMR).
Invasively diagnosed CMD is associated with a 2.5-fold increase in MACE and a 3-fold increase in cardiovascular mortality. This finding highlights the importance of a more comprehensive assessment of coronary vasculature, including both the macro- and the microcirculation.
Authors
Kyriakoulis Kyriakoulis, Dimitriadis Dimitriadis, Sakalidis Sakalidis, Pyrpyris Pyrpyris, Adamopoulou Adamopoulou, Soulaidopoulos Soulaidopoulos, Tsioufis Tsioufis, Doundoulakis Doundoulakis, Papanikolaou Papanikolaou, Aznaouridis Aznaouridis, Galanis Galanis, Odanovic Odanovic, Ilic Ilic, Omerovic Omerovic, Cenko Cenko, Tsioufis Tsioufis
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