Li Yunze, Duan Jinlan, Liu Hongxu, Lin Sheng, Xu Hongkun, Li Xiang
Graduate School, Beijing University of Chinese Medicine, Beijing, China.
Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China.
Front Cardiovasc Med. 2025 Aug 4;12:1620204. doi: 10.3389/fcvm.2025.1620204. eCollection 2025.
Coronary microvascular dysfunction (CMD) in post-percutaneous coronary intervention (PCI) target vessels is increasingly recognized as a critical determinant of adverse cardiovascular outcomes, yet its prevalence and prognostic implications remain poorly characterized. We conducted a systematic review and meta-analysis to determine the prevalence of CMD in post-PCI target vessels and its associated clinical outcomes.
We conducted a systematic review and meta-analysis of observational studies using quantitative coronary physiological assessments to evaluate CMD in post-PCI target vessels. Databases (PubMed, Embase, Web of Science) were searched from inception to January 2025. The pooled Prevalence, multivariable-adjusted hazard ratio (HR) and 95% confidence interval (CI) for clinical outcomes were calculated using random-effects models.
A total of 21 observational studies involving 6,632 patients were included. The pooled prevalence of CMD in post-PCI target vessels was 41.66% (95% CI: 34.18%-49.34%). Subgroup analyses revealed numerical variations in CMD prevalence across assessment methods, sex, clinical diagnoses, and target vessels, though intergroup differences did not reach statistical significance (all > 0.05). The pooled prevalence of CMD was numerically higher in females (46.22% vs. 36.73% in males), patients with acute coronary syndrome (42.37% vs. 36.04% in chronic coronary syndrome), and those assessed via non-wire-based methods (44.72% vs. 35.65% in wire-based methods). CMD prevalence was comparable across target vessels (left anterior descending artery: 37.34%, left circumflex artery: 38.50%, right coronary artery: 39.09%). Patients with post-PCI thrombolysis in myocardial infarction (TIMI) flow grade ≤2 exhibited higher CMD prevalence than those with TIMI flow grade 3, with a statistically significant difference (75.36% vs. 37.26%, = 0.0012). CMD in post-PCI target vessels was independently associated with a 3.10-fold increased risk of major adverse cardiovascular events (95% CI: 2.06-4.67) and a 4.66-fold risk of cardiac death or heart failure readmission (95% CI: 3.13-6.93).
CMD in post-PCI target vessels is prevalent (approximately 40%) and independently associated with a elevated risk of adverse cardiovascular outcomes. Standardized diagnostic criteria and targeted interventions are urgently needed to improve outcomes in this population.
https://www.crd.york.ac.uk/PROSPERO/, PROSPERO CRD42025637496.
经皮冠状动脉介入治疗（PCI）后靶血管的冠状动脉微血管功能障碍（CMD）越来越被认为是不良心血管结局的关键决定因素，但其患病率和预后意义仍未得到充分描述。我们进行了一项系统评价和荟萃分析，以确定PCI后靶血管中CMD的患病率及其相关临床结局。
我们对使用定量冠状动脉生理评估来评估PCI后靶血管中CMD的观察性研究进行了系统评价和荟萃分析。从数据库建立至2025年1月检索数据库（PubMed、Embase、Web of Science）。使用随机效应模型计算临床结局的合并患病率、多变量调整风险比（HR）和95%置信区间（CI）。
共纳入21项涉及6632例患者的观察性研究。PCI后靶血管中CMD的合并患病率为41.66%（95%CI：34.18%-49.34%）。亚组分析显示，CMD患病率在评估方法、性别、临床诊断和靶血管之间存在数值差异，尽管组间差异未达到统计学意义（均>0.05）。女性CMD的合并患病率在数值上更高（46.22%对男性的36.73%）、急性冠状动脉综合征患者（42.37%对慢性冠状动脉综合征患者的36.04%）以及通过非基于导丝的方法评估的患者（44.72%对基于导丝的方法的35.65%）。各靶血管的CMD患病率相当（左前降支动脉：37.34%，左旋支动脉：38.50%，右冠状动脉：39.09%）。PCI后心肌梗死溶栓（TIMI）血流分级≤2的患者比TIMI血流分级为3的患者表现出更高的CMD患病率，差异有统计学意义（75.36%对37.26%，=0.0012）。PCI后靶血管中的CMD与主要不良心血管事件风险增加3.10倍（95%CI：2.06-4.67）以及心脏死亡或心力衰竭再入院风险增加4.66倍（95%CI：3.13-6.93）独立相关。
PCI后靶血管中的CMD很常见（约为40%），并且与不良心血管结局风险升高独立相关。迫切需要标准化的诊断标准和针对性干预措施来改善该人群的结局。
https://www.crd.york.ac.uk/PROSPERO/，PROSPERO CRD42025637496。
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