Coronary Microcirculatory Function Indicated by Coronary Angiography-Derived Index of Microvascular Resistance in Patients Undergoing Rotational Atherectomy

Hui Li; Xi Peng; Le Li; Yun-Di Feng; Guo-Dong Tang; Ying Zhao; Guo-Jian Yang; Nai-Xin Zheng; Fu-Cheng Sun; Hu Ai; Hui-Ping Zhang

doi:10.31083/j.rcm2310330

Coronary Microcirculatory Function Indicated by Coronary Angiography-Derived Index of Microvascular Resistance in Patients Undergoing Rotational Atherectomy

Rev Cardiovasc Med. 2022 Sep 28;23(10):330. doi: 10.31083/j.rcm2310330. eCollection 2022 Oct.

Authors

Hui Li¹, Xi Peng¹, Le Li², Yun-Di Feng³, Guo-Dong Tang¹, Ying Zhao¹, Guo-Jian Yang¹, Nai-Xin Zheng¹, Fu-Cheng Sun¹, Hu Ai¹, Hui-Ping Zhang¹

Affiliations

¹ Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730 Beijing, China.
² Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, 100037 Beijing, China.
³ PKU-HKUST Shenzhen-Hong Kong Institution, 518063 Shenzhen, Guangdong, China.

Abstract

Background: There are scarce published data reporting the effect of rotational atherectomy (RA) on coronary microcirculation function.

Objectives: We aimed to evaluate coronary microcirculation function indicated by the coronary angiography-derived index of microvascular resistance (caIMR) in patients undergoing RA.

Methods: RA procedures between January 2013 and December 2021 were retrospectively analyzed. We investigated coronary microcirculation function indicated by caIMR as well as peri-procedural adverse events among the study population. All caIMR measurements were performed using a FlashAngio system. The primary outcome was a composite of post-RA thrombolysis in myocardial infarction (TIMI) flow grade $<$ 3 in the target vessel, myocardial injury, procedure-related myocardial infarction, and cardiac death during hospitalization.

Results: A total of 155 RA procedures were analyzed. The post-RA caIMRs were significantly higher than pre-RA caIMRs in the target vessels (16.0 $\pm$ 7.0 vs. 14.5 $\pm$ 7.5, p = 0.029). Patients with post-RA caIMR $\geq$ 25 accounted for nearly 12% of those with pre-RA caIMR $<$ 25. Patients with post-RA thrombolysis in myocardial infarction (TIMI) flow grade $<$ 3 had a significantly higher pre-RA caIMR (23.5 $\pm$ 10.2 vs. 13.7 $\pm$ 6.6, p = 0.005), and the proportion of patients with pre-RA caIMR $\geq$ 25 in the group with TIMI flow grade $<$ 3 was greater (61.5% vs. 38.5%, p $<$ 0.001) than that in the group with TIMI flow grade of 3. Maximum RA time of each pass (odds ratio: 1.127, 95% confidence interval: 1.025-1.239, p = 0.014) and pre-RA caIMR $\geq$ 25 (odds ratio: 3.254, 95% confidence interval: 1.054-10.048, p = 0.040) were identified to be the independent predictors of the primary outcome for patients who underwent RA.

Conclusions: There were significant changes in the coronary microcirculation function of the target vessels after receiving RA as indicated by increased post-RA caIMR compared to pre-RA caIMR. Patients with baseline coronary microcirculatory dysfunction were more likely to have post-RA TIMI flow grade $<$ 3, whereas those with pre-RA caIMR $\geq$ 25 experienced worse outcomes.

Keywords: coronary artery disease; coronary microcirculation; index of microvascular resistance; percutaneous coronary intervention; rotational atherectomy.