SYSTEMATIC REVIEW article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1620204
This article is part of the Research TopicCoronary Physiology in the Spotlight: Advancing Diagnosis and Treatment in CAD and Microvascular DiseaseView all articles
Coronary microvascular dysfunction in post-PCI target vessels: a systematic review and meta-analysis of prevalence and associated outcomes
Provisionally accepted
- 1Beijing University of Chinese Medicine, Beijing, China
- 2Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- 3Air China Health Center Outpatient Department, Beijing, China
- 4Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Background: Coronary microvascular dysfunction (CMD) in post-percutaneous coronary intervention (PCI) target vessels is increasingly recognized as a critical determinant of adverse cardiovascular outcomes, yet its prevalence and prognostic implications remain poorly characterized. We conducted a systematic review and meta-analysis to determine the prevalence of CMD in post-PCI target vessels and its associated clinical outcomes.We conducted a systematic review and meta-analysis of observational studies using quantitative coronary physiological assessments to evaluate CMD in post-PCI target vessels. Databases (PubMed, Embase, Web of Science) were searched from inception to January 2025. The pooled Prevalence, multivariable-adjusted hazard ratio (HR) and 95% confidence interval (CI) for clinical outcomes were calculated using random-effects models.Results: A total of 21 observational studies involving 6,632 patients were included.The pooled prevalence of CMD in post-PCI target vessels was 41.66% (95% CI: 34.18-49.34%). Subgroup analyses revealed numerical variations in CMD prevalence across assessment methods, sex, clinical diagnoses, and target vessels, though intergroup differences did not reach statistical significance (all P > 0.05). The pooled prevalence of CMD was numerically higher in females (46.22% vs. 36.73% in males), patients with acute coronary syndrome (42.37% vs. 36.04% in chronic coronary syndrome), and those assessed via non-wire-based methods (44.72% vs. 35.65% in wire-based methods). CMD prevalence was comparable across target vessels (left anterior descending artery: 37.34%, left circumflex artery: 38.50%, right coronary artery: 39.09%). Patients with post-PCI thrombolysis in myocardial infarction (TIMI) flow grade ≤ 2 exhibited higher CMD prevalence than those with TIMI flow grade 3, with a statistically significant difference (75.36% vs. 37.26% , P = 0.0012). CMD in post-PCI target vessels was independently associated with a 3.10-fold increased risk of major adverse cardiovascular events (95% CI: 2.06-4.67) and a 4.66-fold risk of cardiac death or heart failure readmission (95% CI: 3.13-6.93).CMD in post-PCI target vessels is prevalent (approximately 40%) and independently associated with a elevated risk of adverse cardiovascular outcomes.Standardized diagnostic criteria and targeted interventions are urgently needed to improve outcomes in this population.
Keywords: Coronary microvascular dysfunction, Percutaneous Coronary Intervention, Prevalence, outcomes, Meta-analysis
Received: 20 May 2025; Accepted: 18 Jul 2025.
Copyright: © 2025 Li, Duan, Liu, Lin, Xu and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Hongxu Liu, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
Xiang Li, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
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