Coronary Microcirculatory Function Indicated By Coronary Angiography-Derived Index Of Microvascular Resistance In Patients Undergoing Rotational Atherectomy

Objectives:There are scarce published data reporting the effect of rotational atherectomy(RA)on coronary microcirculation function.We aimed to evaluate coronary microcirculation function indicated by the coronary angiography-derived index of microvascular resistance(caIMR)in patients undergoing RA.Methods:This is a retrospective project study.RA procedures between January 2013 and December 2021 were retrospectively analyzed.We investigated coronary microcirculation function indicated by caIMR as well as peri-procedural adverse events among the study population.All caIMR measurements were performed using a FlashAngio system.The primary outcome was a composite of postoperative TIMI flow grade<3 in the target vessel,procedure-related myocardial infarction,and cardiac death during hospitalization.Results:A total of 155 RA procedures were analyzed.The post-RA caIMR were significantly higher than pre-RA caIMR in the target vessels[14.6(10.85,19.1)vs.12.6(9.15,18.45),P=0.023].Patients with TIMI<3 had higher preoperative calMR compared to patients with normal coronary flow[26.20(14.05,31.00)vs.12.30(9.06,17.93),P<0.001].Similarly,patients with TIMI<3 had higher postoperative caIMR[27.10(19.25,31.40)vs.14.45(10.68,18.38),P<0.001].Estimated glomerular filtration rate(eGFR)(OR:0.98,95%CI:0.96-1.00,P=0.015)and preoperative caIMR 25(OR:26.12,95%CI:6.77-136.71,P<0.001)were independent risk factors for the primary outcome.Conclusions:The coronary microvascular function of target vessels changed significantly after RA treatment,which showed that caIMR increased after RA compared with that before RA.Patients with baseline coronary microvascular dysfunction are more likely to have TIMI flow grade<3 after RA,while patients with renal dysfunction and preoperative caIMR ≥ 25 have a worse prognosis.