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Coronary disease & ACSCohort study

Microvascular resistance reserve and cardiovascular outcomes: the FLOW-CMD registry

Eur Heart JPublished

  • Prospective cohort study
  • multicentre
  • registry
  • consecutive patients
Read the original article ↗

Authors' conclusion

In patients with suspected ischaemic heart disease undergoing invasive coronary angiography, coronary microvascular dysfunction defined by MRR ≤2.5 was observed among one-third of patients, and was associated with an increased risk of a composite of all-cause death, myocardial infarction, clinically-driven repeat revascularisation, or hospitalisation for heart failure

Study context

Population
Consecutive patients with suspected ischaemic heart disease undergoing clinically indicated invasive coronary angiography with comprehensive coronary physiologic assessment
Participants
1,003 patients
Exposure
Coronary microvascular dysfunction vs preserved microvascular function
  • Coronary microvascular dysfunctionn = 334
  • Preserved microvascular functionn = 669reference
Outcome
Composite of:
  • All-cause death
  • MI
  • Clinically-driven repeat revascularisation
  • Hospitalisation for HF
Follow-up
Median 1.9 years

Main finding

As reported in the abstract

Coronary microvascular dysfunction vs Preserved microvascular functionEstimate (95% CI)P value
Coronary microvascular dysfunction
HR 1.94(1.30–2.90)
P = 0.001
multivariable analysis
adjusted HR 1.78(1.06–2.99)
P = 0.030

Observational data: associations, not effects.

Further findings

OutcomeHR (95% CI)P value
Primary endpoint, MRR as a continuous variable1.16 (1.03–1.32)P = 0.026

Prevalence of coronary microvascular dysfunction (microvascular resistance reserve (MRR) ≤2.5)

Coronary microvascular dysfunction identified in 334 of 1003 patients
33.3%

Original publication

Microvascular resistance reserve and cardiovascular outcomes: the FLOW-CMD registry. Eur Heart J. Published 28 August 2026. doi:10.1093/eurheartj/ehag705
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Summarised from the published abstract; every number is checked against it