IMR Press / RCM / Volume 23 / Issue 10 / DOI: 10.31083/j.rcm2310330
Open Access Original Research
Coronary Microcirculatory Function Indicated by Coronary Angiography-Derived Index of Microvascular Resistance in Patients Undergoing Rotational Atherectomy
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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: (Hu Ai); (Hui-Ping Zhang)
These authors contributed equally.
Academic Editors: Zhonghua Sun, Yung-Liang Wan and Brian Tomlinson
Rev. Cardiovasc. Med. 2022, 23(10), 330;
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)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

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 ± 7.0 vs. 14.5 ± 7.5, p = 0.029). Patients with post-RA caIMR 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 ± 10.2 vs. 13.7 ± 6.6, p = 0.005), and the proportion of patients with pre-RA caIMR 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 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 25 experienced worse outcomes.

coronary artery disease
percutaneous coronary intervention
rotational atherectomy
coronary microcirculation
index of microvascular resistance
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
Fig. 1.
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