An international study suggests that coronary microvascular dysfunction (CMD) is a major contributor to residual angina and reduced quality of life in patients who undergo successful percutaneous coronary intervention (PCI). Led by Frédéric Bouisset, MD, from the Hopital de Rangueil Chu Toulouse in France, the team found CMD to be present in 86 out of 242 patients with significant coronary lesions (FFR ≤ 0.80) who underwent PCI. “One in four patients after angiographically ‘successful’ PCI has residual angina,” Dr Bouisset said on Thursday during a Late-Breaking Trial session at the EuroPCR Congress 2025 in Paris. “CMD has been proposed as one of the underlying mechanisms… patients presenting CMD have a higher symptom burden at baseline,” he added. CMD and CAD More significantly, the data suggested no significant correlation between CMD and the pattern of coronary artery disease, whether focal or diffuse. Dr. Bouisset stated in his presentation that CMD was equally prevalent in focal and diffuse disease. However, the presence of CMD was particularly impactful in cases of focal disease. “Underlying CMD is associated with residual angina only in focal CAD,” Dr. Bouisset explained, emphasizing the importance of considering microvascular health, especially in patients with focal stenosis. Less improvement Further findings revealed that in the 12-month follow-up, patients with CMD showed less improvement across several domains of the Seattle Angina Questionnaire (SAQ-7). This included angina frequency and quality of life. Additionally, among focal CAD patients, CMD was associated with significantly worse scores (Angina Frequency 95.3 ± 9.79 vs 92.95 ± 12.68, p=0.033; Quality of Life 84.38 ± 21.27 vs 78.69 ± 25.37, p=0.017; Summary Score 88.78 ± 15.44 vs 84.1 ± 18.89, p=0.01). “To elucidate the mechanisms of residual angina after PCI by comprehensively assessing the (epicardial and microvascular) coronary circulation” remains a key objective in improving long-term patient outcomes, Dr Bouisset concluded. Methodology The study population included patients with hemodynamically significant coronary artery disease, defined by a fractional flow reserve (FFR) ≤ 0.80, who were scheduled for PCI. Enrollment took place across 25 sites in Europe. In total, 242 patients were included in the final analysis with the gender distribution showing that 73.1% were male (n=177) and 26.9% were female. The mean age of participants was approximately 68 years. Patient-reported outcomes were measured using 7 item SAQ-7 version. These outcomes were collected at baseline and at 1-year follow-up. The primary endpoint was the change in SAQ-7 scores over one year, with specific attention to differences between patients with and without CMD. Image Credit: New Africa – stock.adobe.com