Coronary microvascular disease in patients referred to coronary angiography following coronary computed tomography angiography
Authors' conclusion
CMD, as identified with bolus thermodilution, is common in patients referred to invasive coronary angiography based on suspected obstructive epicardial CAD even in patients with normal stress myocardial blood flow by 82Rb-PET. (ClinicalTrials.gov: NCT02264717 and NCT04707859).
Study context
- Population
- Symptomatic patients with suspected obstructive epicardial coronary artery disease (CAD) on coronary computed tomography angiography, referred to 82Rb-PET and invasive coronary angiography with bolus thermodilution
- Participants
- 561 patients
- Exposure
- Myocardial perfusion characteristics by 82Rb-PET and health status according to CAD classification (no disease, obstructive epicardial CAD, isolated coronary microvascular disease (CMD) or combined obstructive epicardial CAD and CMD)
- Isolated CMDn = 131
- Outcome
- Prevalence of isolated CMD
Main finding
As reported in the abstract
Isolated CMD
0.23
131 of 131
Observational data: associations, not effects.
Further findings
| Outcome | Mean difference (mL/min/g) (95% CI) | |
|---|---|---|
| Hyperaemic myocardial blood flow, vessel territoriesIsolated CMD vs no disease | 0.03 (−0.13 to 0.06) | |
| −0.2−0.100.1Difference, mL/min/g (linear scale) |
| Outcome | OR (95% CI) | |
|---|---|---|
| Being angina-free · 3 monthsIsolated CMD vs no disease · tended to be lower for the CMD group | 0.56 (0.31–1.00) | |
| Being angina-free · 3 monthsRevascularised epicardial disease vs no disease | 1.52 (0.94–2.48) | |
| 0.20.5125Odds ratio (log scale) |
- Hyperaemic myocardial blood flow, vessel territories: isolated CMD territories similar to non-diseased vessels (no direction sign printed)
- Being angina-free: tended to be higher for the revascularised epicardial disease group
Hyperaemic myocardial blood flow, vessel territories
- Vessel territories with isolated CMD were characterised by similar perfusion characteristics to non-diseased vessels
Stress myocardial blood flow, isolated epicardial disease
- Reduced stress myocardial blood flow with isolated epicardial disease on both patient and vessel levels compared to patients without disease
Original publication
Coronary microvascular disease in patients referred to coronary angiography following coronary computed tomography angiography. EuroIntervention. Published 1 September 2025. doi:10.
Summarised from the published abstract; every number is checked against it