Corcoran, D. et al. (2018) Coronary microvascular dysfunction in patients with stable coronary artery disease: the CE-MARC 2 coronary physiology sub-study. International Journal of Cardiology, 266, pp. 7-14. (doi: 10.1016/j.ijcard.2018.04.061) (PMID:29716756) (PMCID:PMC6008494)
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Abstract
In patients with angina undergoing invasive management, no obstructive coronary artery disease (NOCAD) is a common finding, and angina may persist following percutaneous coronary intervention (PCI). Coronary microvascular dysfunction may be relevant. We aimed to assess the proportion of patients presenting with suspected CAD who had coronary microvascular dysfunction. Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2 (CE-MARC 2) was a prospective multicenter randomised controlled trial of functional imaging versus guideline-based management in patients with suspected CAD. Invasive coronary angiography was protocol-directed. Fractional flow reserve (FFR) and parameters of microvascular function (coronary flow reserve (CFR), index of microcirculatory resistance (IMR), resistance reserve ratio (RRR)) were measured in major epicardial coronary arteries with ≥40-≤90% diameter stenosis. An FFR value ≤0.80 indicated the presence of obstructive CAD. 267/1202 (22.2%) patients underwent angiography and 81 (30%) patients had FFR measured. 63 (78%) of these patients had microvascular function assessed in 85 arteries (mean age 58.5 ± 8.2 years; 47 (75%) male). 25/63 (40%) patients had NOCAD, and of these, 17 (68%) had an abnormality ≥1 parameter of microvascular function (abnormal IMR (≥25), abnormal CFR (<2.0), and abnormal RRR (<2.0) occurred in 10 (40%), 12 (48%), and 11 (44%), respectively). 38/63 (60%) patients had obstructive epicardial CAD. Of these patients, 15/38 (39%), 20/38 (53%), and 12/38 (32%) had an abnormal IMR, CFR and RRR, respectively. Coronary microvascular dysfunction is common in patients with angina. Invasive assessment of microvascular function may be informative and relevant for decision-making in patients with both NOCAD and obstructive epicardial CAD. ClinicalTrials.gov Identifier: NCT01664858.
| Item Type: | Articles |
|---|---|
| Keywords: | Angina, coronary artery disease, coronary microvascular dysfunction, stable ischaemic heart disease. |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Berry, Professor Colin and McConnachie, Professor Alex and Oldroyd, Dr Keith and Young, Dr Robin and Corcoran, Dr David and Mangion, Dr Kenneth |
| Authors: | Corcoran, D., Young, R., Adlam, D., McConnachie, A., Mangion, K., Ripley, D., Cairns, D., Brown, J., Bucciarelli-Ducci, C., Baumbach, A., Kharbanda, R., Oldroyd, K. G., McCann, G. P., Greenwood, J. P., and Berry, C. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre |
| Journal Name: | International Journal of Cardiology |
| Publisher: | Elsevier |
| ISSN: | 0167-5273 |
| ISSN (Online): | 1874-1754 |
| Published Online: | 19 April 2018 |
| Copyright Holders: | Copyright © 2018 The Authors |
| First Published: | First published in International Journal of Cardiology 266: 7-14 |
| Publisher Policy: | Reproduced under a Creative Commons License |
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