Coronary Microvascular Dysfunction Signals Higher Cardiovascular Risk

Coronary microvascular dysfunction (CMD) was common in patients undergoing invasive coronary angiography and was associated with nearly double the risk of major cardiovascular events. In this prospective multicenter study from South Korea involving 1,003 patients with suspected ischemic heart disease, CMD was identified in 21.5% of patients with obstructive epicardial coronary artery disease and in 9.3% of those without obstructive disease. CMD was defined by reduced coronary flow reserve (<2.0) and elevated index of microcirculatory resistance (≥25) during invasive physiological assessment. Over a median follow-up of 1.9 years, patients with CMD had significantly higher rates of the composite outcome of all-cause death, myocardial infarction, repeat revascularization, or hospitalization for heart failure compared with those with preserved microvascular function (18.8% vs 10.5%; HR 1.91). These findings highlight that CMD frequently coexists with epicardial coronary disease and carries important prognostic implications in routine clinical practice. Source: https://www.thelancet.com/