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Meta-Analysis
. 2022 May 16;17(5):e0268330.
doi: 10.1371/journal.pone.0268330. eCollection 2022.

Prognostic significance of severe coronary microvascular dysfunction post-PCI in patients with STEMI: A systematic review and meta-analysis

Marjorie Canu  1 , Charles Khouri  2   3 , Stéphanie Marliere  1 , Estelle Vautrin  1 , Nicolas Piliero  1 , Olivier Ormezzano  1   4 , Bernard Bertrand  1 , Hélène Bouvaist  1 , Laurent Riou  4 , Loic Djaileb  4 , Clémence Charlon  1   4 , Gerald Vanzetto  1   4   5 , Matthieu Roustit  2   3 , Gilles Barone-Rochette  1   4   5
Affiliations
Meta-Analysis

Prognostic significance of severe coronary microvascular dysfunction post-PCI in patients with STEMI: A systematic review and meta-analysis

Marjorie Canu et al. PLoS One. .

Abstract

Coronary microvascular dysfunction (CMVD) is common and associated with poorer outcomes in patients with ST Segment Elevation Myocardial Infarction (STEMI). The index of microcirculatory resistance (IMR) and the index of hyperemic microvascular resistance (HMR) are both invasive indexes of microvascular resistance proposed for the diagnosis of severe CMVD after primary percutaneous coronary intervention (pPCI). However, these indexes are not routinely assessed in STEMI patients. Our main objective was to clarify the association between IMR or HMR and long-term major adverse cardiovascular events (MACE), through a systematic review and meta-analysis of observational studies. We searched Medline, PubMed, and Google Scholar for studies published in English until December 2020. The primary outcome was a composite of cardiovascular death, non-cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, and rehospitalization for heart failure occurring after at least 6 months following CMVD assessment. We identified 6 studies, reporting outcomes in 1094 patients (mean age 59.7 ± 11.4 years; 18.2% of patients were women) followed-up from 6 months to 7 years. Severe CMVD, defined as IMR > 40 mmHg or HMR > 3mmHg/cm/sec was associated with MACE with a pooled HR of 3.42 [2.45; 4.79]. Severe CMVD is associated with an increased risk of long-term adverse cardiovascular events in patients with STEMI. Our results suggest that IMR and HMR are useful for the early identification of severe CMVD in patients with STEMI after PCI, and represent powerful prognostic assessments as well as new therapeutic targets for clinical intervention.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of the study selection process using PRISMA tool.
CMVD = coronary microvascular dysfunction; MACE = Major Adverse Cardiovascular Events; CABG = Coronary artery bypass graft; CAD = coronary artery disease.
Fig 2
Fig 2. Quality of included studies using QUIPS tool.
QUIPS = Quality in Prognostic Studies.
Fig 3
Fig 3. Forest plot of MACE with and without severe CMVD.
CMVD was significantly associated with an increased risk of MACE, with a pooled HR of 3.42 [2.45; 4.79]. Squares and diamonds = hazard ratios, lines = 95% CI. TE = treatment effect; SE = standard errors; MACE = Major Adverse Cardiovascular Events; CMVD = coronary microvascular dysfunction; CI = confidence interval.
Fig 4
Fig 4. Sensitivity analyses.
Sensitivity analyses consisted in repeating the forest plot after removing 3 studies at high risk of bias.
Fig 5
Fig 5. GRADE framework.
Quality of evidence using GRADE framework adapted to prognostic factor studies. GRADE = Grading of Recommandations, Assessment, Development and Evaluations.
Fig 6
Fig 6. Funnel plot.
The funnel plot showed no asymmetry, suggesting no publication biais.
See this image and copyright information in PMC

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