BACKGROUND The prognostic impact of coronary microvascular dysfunction after percutaneous coronary intervention (PCI) remains unclear in patients with stable coronary artery disease. This study sought to investigate the prognostic value of microvascular function measured immediately after PCI in patients with stable coronary artery disease. METHODS We enrolled 572 patients with stable coronary artery disease who underwent PCI and elective measurement of the index of microcirculatory resistance (IMR) immediately after PCI from 8 centers in 4 countries. Impaired microvascular function was defined as IMR≥25 (high IMR). Major adverse cardiac events, including death, myocardial infarction (MI) and target vessel revascularization, were evaluated. RESULTS During a median follow-up duration of 4.0 years, the cumulative major adverse cardiac events rate was significantly higher in the high IMR group (n=66/148) compared with the low IMR group (n=128/424; hazard ratio [HR], 1.56; 95% CI, 1.16-2.105; P=0.001), primarily due to a higher rate of periprocedural MI (HR, 1.59; 95% CI, 1.11-2.28; P=0.004) but also due to higher rates of mortality (HR, 1.59; 95% CI, 0.76-3.35; P=0.22), spontaneous MI (HR, 2.10; 95% CI, 0.67-6.63; P=0.20) and target vessel revascularization (HR, 1.40; 95% CI, 0.77-2.54; P=0.27). Cumulative risk for death, spontaneous MI, and target vessel revascularization was higher in the high IMR group (HR, 1.55; 95% CI, 0.99-2.43; P=0.056), as was death and spontaneous MI alone (HR, 1.79; 95% CI, 0.96-3.36; P=0.065). On multivariable analysis, high IMR post-PCI was an independent predictor of major adverse cardiac events. CONCLUSIONS IMR measured immediately after PCI predicts adverse events in patients with stable coronary artery disease.

中文翻译：

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在稳定的冠状动脉疾病中经皮冠状动脉介入治疗后立即测量的冠状动脉微血管功能的预后价值：一项国际多中心研究。

背景技术经皮冠状动脉介入治疗（PCI）后，冠状动脉微血管功能障碍的预后影响在稳定冠状动脉疾病患者中尚不清楚。这项研究试图调查在稳定冠状动脉疾病患者中PCI后立即测量的微血管功能的预后价值。方法我们从4个国家的8个中心招募了572例稳定的冠状动脉疾病患者，这些患者接受了PCI，并在PCI后立即进行了选择性微循环阻力指数（IMR）的选择性测量。微血管功能受损定义为IMR≥25（高IMR）。评价了主要的不良心脏事件，包括死亡，心肌梗塞（MI）和目标血管血运重建。结果在平均4.0年的随访期间，高IMR组（n = 66/148）的累积主要主要不良心脏事件发生率显着高于低IMR组（n = 128/424；危险比[HR]为1.56； 95％CI为1.16-2.105 ； P = 0.001），主要是由于围手术期心肌梗死发生率较高（HR，1.59； 95％CI，1.11-2.28； P = 0.004），也由于死亡率较高（HR，1.59； 95％CI，0.76） -3.35； P = 0.22），自发性心梗（HR，2.10； 95％CI，0.67-6.63； P = 0.20）和目标血管血运重建（HR，1.40； 95％CI，0.77-2.54； P = 0.27）。高IMR组的死亡，自发性MI和靶血管血运重建的累积风险较高（HR，1.55; 95％CI，0.99-2.43; P = 0.056），单独死亡和自发性MI也如此（HR，1.79; 95） ％CI，0.96-3.36； P ＝ 0.065）。在多变量分析中，PCI后的高IMR是主要不良心脏事件的独立预测因子。