Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 May 23;13(6):1289.
doi: 10.3390/biomedicines13061289.

Coronary Microvascular Disease Early After Myocardial Infarction: Diagnostic Approach and Prognostic Value-A Narrative Review

Stefanos Sokratous  1 , Andreas Mitsis  2 , Elina Khattab  1 , Dimitrios Karelas  3 , Nikolaos Velidakis  1 , Nikolaos P E Kadoglou  1
Affiliations
Review

Coronary Microvascular Disease Early After Myocardial Infarction: Diagnostic Approach and Prognostic Value-A Narrative Review

Stefanos Sokratous et al. Biomedicines. .

Abstract

Coronary microvascular disease (CMVD) is not an uncommon complication after acute myocardial infarction (AMI), independent of prompt revascularization. It is a serious yet underdiagnosed disease that has a major impact on patient outcomes. Even when the infarct-related artery is successfully revascularized, a significant percentage of patients still have compromised microvascular circulation, which is linked to higher cardiovascular mortality and hospitalization for heart failure. The well-known invasive methods, such as the index of microvascular resistance (IMR) and the coronary flow reserve (CFR), have been considered as gold standards. However, they are constrained by their hazards and complexity. Non-invasive techniques, such as echocardiography Doppler for CFR assessment, positron emission tomography (PET), cardiac magnetic resonance imaging (CMR), and some other techniques provide alternatives, but their accessibility, cost and implementation during the peri-AMI period raise obstacles to their wider use. This review highlights both invasive and non-invasive modalities as it examines the diagnostic methods and prognostic significance of CMVD development early after AMI. Enhancing long-term results in this high-risk population requires a thorough understanding of pathophysiology and a commitment to larger diagnostic and prognostic studies for CMVD.

Keywords: acute myocardial infarction (AMI); coronary flow reserve (CFR); coronary microvascular disease (CMVD); index of microcirculatory resistance (IMR); major adverse cardiovascular events (MACE); microvascular obstruction (MVO); percutaneous coronary intervention (PCI).

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Potential mechanisms of coronary microvascular disease after acute myocardial infarction.
Figure 2
Figure 2
Representative example of CFR calculation using echocardiography.
Figure 3
Figure 3
Invasive and non-invasive techniques for CMVD diagnosis.
Figure 4
Figure 4
A diagnostic decision flowchart.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Kunadian V., Chieffo A., Camici P.G., Berry C., Escaned J., Maas A.H.E.M., Prescott E., Karam N., Appelman Y., Fraccaro C., et al. An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group. Eur. Heart J. 2020;41:3504–3520. doi: 10.1093/eurheartj/ehaa503. - DOI - PMC - PubMed
    1. Saad M., Stiermaier T., Fuernau G., Pöss J., De Waha-Thiele S., Desch S., Thiele H., Eitel I. Impact of Direct Stenting on Myocardial Injury Assessed by Cardiac Magnetic Resonance Imaging and Prognosis in ST-Elevation Myocardial Infarction. Int. J. Cardiol. 2019;283:88–92. doi: 10.1016/j.ijcard.2018.11.141. - DOI - PubMed
    1. Feng C., Abdu F.A., Mohammed A.-Q., Zhang W., Liu L., Yin G., Feng Y., Mohammed A.A., Mareai R.M., Lv X., et al. Prognostic Impact of Coronary Microvascular Dysfunction Assessed by caIMR in Overweight with Chronic Coronary Syndrome Patients. Front. Endocrinol. 2022;13:922264. doi: 10.3389/fendo.2022.922264. - DOI - PMC - PubMed
    1. Pries A.R., Badimon L., Bugiardini R., Camici P.G., Dorobantu M., Duncker D.J., Escaned J., Koller A., Piek J.J., De Wit C. Coronary Vascular Regulation, Remodelling, and Collateralization: Mechanisms and Clinical Implications on Behalf of the Working Group on Coronary Pathophysiology and Microcirculation. Eur. Heart J. 2015;36:3134–3146. doi: 10.1093/eurheartj/ehv100. - DOI - PubMed
    1. Coronary Microvascular Disease Pathogenic Mechanisms and Therapeutic Options: JACC State-of-the-Art Review|JACC. [(accessed on 31 March 2025)]. Available online: https://www.jacc.org/doi/10.1016/j.jacc.2018.09.042. - DOI

LinkOut - more resources