Microvascular Resistance Reserve and Outcomes in Angina and Nonobstructive Coronary Artery Disease
Authors' conclusion
In this study, CMD assessed by continuous thermodilution-derived MRR was not associated with clinical outcomes.
Study context
- Population
- Consecutive patients with and nonobstructive coronary arteries (ANOCA) who underwent continuous thermodilutionmean [SD] age, 59.1 [9.6] years, 459 female [83.0%]
- Participants
- 553 patients
- Exposure
- Abnormal vs gray zone vs normal microvascular resistance reserve (MRR)
- Abnormal MRR (coronary microvascular dysfunction (CMD))n = 94
- Gray zone MRRn = 98
- Normal MRRn = 361
- Outcome
- Composite of:
- All-cause death
- Acute coronary syndrome
- Stroke
- Clinically indicated revascularization
- Repeat angiography without intervention
- Unplanned hospital admittance or emergency department visit due to angina or heart failure
- Follow-up
- Mean (SD) 27.5 (16.1) months
Methodological detailswithin the Netherlands Registry of Invasive Coronary Vasomotor Function Testing (NL-CFT), 4 clinical centers in the Netherlands, Clinical events were adjudicated by investigators blinded to CFT results
- Within the Netherlands Registry of Invasive Coronary Vasomotor Function Testing (NL-CFT)
- 4 clinical centers in the Netherlands
- Clinical events were adjudicated by investigators blinded to CFT results
Main finding
As reported in the abstract
Observational data: associations, not effects.
Secondary outcomes
| Outcome | Abnormal MRR (CMD) | Normal MRR | P value |
|---|---|---|---|
| Angina (SAQ summary score) · follow-upAbnormal MRR (CMD) vs Normal MRR · worse angina with low MRR · mean | 53.0 (SD 16.7) | 60.1 (SD 16.6) | P = 0.04 |
| Clinically relevant improvementAbnormal MRR (CMD) vs Normal MRR · less clinically relevant improvement with low MRR | 30.0% | 59.1% | P = 0.02 |
CMD prevalence
- CMD observed
- 94 patients (17.0%)
Individual outcomes
- Individual outcomes did not differ between groups
Seattle Angina Questionnaire (SAQ) summary scores, longitudinal interaction with MRR
- No overall longitudinal interaction between MRR and SAQ summary scores
Symptom burden · baseline
- Low MRR (abnormal vs normal groups) was not associated with an increased symptom burden at baseline
Original publication
Microvascular Resistance Reserve and Outcomes in Angina and Nonobstructive Coronary Artery Disease. JAMA Cardiol. Published 1 November 2026. doi:10.
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