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

Hui Li^1,†, Xi Peng^1,†, Le Li², Yun-Di Feng³, Guo-Dong Tang¹, Ying Zhao¹, Guo-Jian Yang¹, Nai-Xin Zheng¹, Fu-Cheng Sun¹, Hu Ai^1,*, Hui-Ping Zhang^1,*

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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

^*Correspondence: aihumd@aliyun.com (Hu Ai); huipingzhang73@163.com (Hui-Ping Zhang)
^†These authors contributed equally.
Academic Editors: Zhonghua Sun, Yung-Liang Wan and Brian Tomlinson

Rev. Cardiovasc. Med. 2022, 23(10), 330; https://doi.org/10.31083/j.rcm2310330

Submitted: 24 July 2022 | Revised: 24 August 2022 | Accepted: 24 August 2022 | Published: 28 September 2022

(This article belongs to the Special Issue New insight in Cardiovascular Imaging)

This is an open access article under the CC BY 4.0 license.

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

percutaneous coronary intervention

rotational atherectomy

coronary microcirculation

index of microvascular resistance

Funding

BJ-2018-201/National High Level Hospital Clinical Research Funding

2021-I2M-C&T-A-019/Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences

Z211100002921008/Beijing Municipal Science & Technology Commission, Administrative Commission of Zhongguancun Science Park

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Rev. Cardiovasc. Med. Print ISSN 1530-6550 Electronic ISSN 2153-8174