Tang N, Li KM, Li HR, Zhang QD, Hao J, Qi CM. Advances in the diagnosis and management of post-percutaneous coronary intervention coronary microvascular dysfunction: Insights into pathophysiology and metabolic risk interactions. World J Cardiol 2025; 17(2): 103950 [DOI: 10.4330/wjc.v17.i2.103950]
Corresponding Author of This Article
Chun-Mei Qi, PhD, Professor, Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, No. 32 Coal Construction Road, Quanshan District, Xuzhou 221000, Jiangsu Province, China. wwtgy12581@163.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Feb 26, 2025; 17(2): 103950 Published online Feb 26, 2025. doi: 10.4330/wjc.v17.i2.103950
Advances in the diagnosis and management of post-percutaneous coronary intervention coronary microvascular dysfunction: Insights into pathophysiology and metabolic risk interactions
Nan Tang, Kang-Ming Li, Hao-Ran Li, Qing-Dui Zhang, Ji Hao, Chun-Mei Qi
Nan Tang, Kang-Ming Li, Hao-Ran Li, Qing-Dui Zhang, Ji Hao, Chun-Mei Qi, Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, Jiangsu Province, China
Author contributions: Tang N conducted the literature review, did the analysis and drafted the original manuscript; Li KM, Li HR, Zhang QD, Hao J and Qi CM conceptualised and designed the study, supervised, and made critical revisions; all authors prepared the draft and approved the submitted version.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chun-Mei Qi, PhD, Professor, Department of Cardiology, The Second Affiliated Hospital of Xuzhou Medical University, No. 32 Coal Construction Road, Quanshan District, Xuzhou 221000, Jiangsu Province, China. wwtgy12581@163.com
Received: December 6, 2024 Revised: January 28, 2025 Accepted: February 10, 2025 Published online: February 26, 2025 Processing time: 81 Days and 17.1 Hours
Abstract
Percutaneous coronary intervention (PCI), as an essential treatment for coronary artery disease, has significantly improved the prognosis of patients with large coronary artery lesions. However, some patients continue to experience myocardial ischemic symptoms post-procedure, largely due to coronary microvascular dysfunction (CMD). The pathophysiological mechanisms of CMD are complex and involve endothelial dysfunction, microvascular remodeling, reperfusion injury, and metabolic abnormalities. Moreover, components of metabolic syndrome, including obesity, hyperglycemia, hypertension, and dyslipidemia, exacerbate the occurrence and progression of CMD through multiple pathways. This review systematically summarizes the latest research advancements in CMD after PCI, including its pathogenesis, diagnostic techniques, management strategies, and future research directions. For diagnosis, invasive techniques such as coronary flow reserve and the index of microcirculatory resistance, as well as non-invasive imaging modalities (positron emission tomography and cardiac magnetic resonance), provide tools for early CMD detection. In terms of management, a multi-level intervention strategy is emphasized, incorporating lifestyle modifications (diet, exercise, and weight control), pharmacotherapy (vasodilators, hypoglycemic agents, statins, and metabolic modulators), traditional Chinese medicine, and specialized treatments (enhanced external counterpulsation, metabolic surgery, and lipoprotein apheresis). However, challenges remain in CMD treatment, including limitations in diagnostic tools and the lack of personalized treatment strategies. Future research should focus on the complex interactions between CMD and metabolic risks, aiming to optimize diagnostic and therapeutic strategies to improve the long-term prognosis of patients post-PCI.
Core Tip: Coronary microvascular dysfunction (CMD) is a significant cause of persistent myocardial ischemia in patients following percutaneous coronary intervention. This review highlights the complex pathophysiology of CMD, which involves endothelial dysfunction, microvascular remodeling, reperfusion injury, and metabolic abnormalities. The interplay between CMD and metabolic syndrome exacerbates microcirculatory dysfunction through inflammation, oxidative stress, and insulin resistance. Advances in diagnostic techniques, including invasive methods like coronary flow reserve and index of microcirculatory resistance, and non-invasive imaging such as positron emission tomography and cardiac magnetic resonance, have improved early detection. Management strategies emphasize a multi-level approach combining lifestyle interventions, pharmacological therapies, and specialized treatments like enhanced external counterpulsation and metabolic surgery. Future research should focus on optimizing diagnostic tools, developing precision therapies, and understanding the genetic and molecular basis of CMD to improve long-term patient outcomes.
