Advances in the diagnosis and management of post-percutaneous coronary intervention coronary microvascular dysfunction:Insights into pathophysiology and metabolic risk interactions  

作　　者：Nan Tang Kang-Ming Li Hao-Ran Li Qing-Dui Zhang Ji Hao Chun-Mei Qi 

机构地区：[1]Department of Cardiology,The Second Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China

出　　处：《World Journal of Cardiology》2025年第2期29-42,共14页世界心脏病学杂志(英文)

摘　　要：Percutaneous coronary intervention(PCI),as an essential treatment for coronary artery disease,has significantly improved the prognosis of patients with large coronary artery lesions.However,some patients continue to experience myocar-dial ischemic symptoms post-procedure,largely due to coronary microvascular dysfunction(CMD).The pathophysiological mechanisms of CMD are complex and involve endothelial dysfunction,microvascular remodeling,reperfusion in-jury,and metabolic abnormalities.Moreover,components of metabolic syndrome,including obesity,hyperglycemia,hypertension,and dyslipidemia,exacerbate the occurrence and progression of CMD through multiple pathways.This review systematically summarizes the latest research advan-cements in CMD after PCI,including its pathogenesis,diagnostic techniques,management strategies,and future research directions.For diagnosis,invasive techniques such as coronary flow reserve and the index of microcirculatory resistance,as well as non-invasive imaging modalities(positron emission tomography and cardiac magnetic reso-nance),provide tools for early CMD detection.In terms of management,a multi-level intervention strategy is emphasized,incorporating lifestyle modifications(diet,exercise,and weight control),pharmacotherapy(vasodilators,hypoglycemic agents,statins,and metabolic modulators),traditional Chinese medicine,and specialized treatments(enhanced external counterpulsation,metabolic surgery,and lipoprotein apheresis).However,challenges remain in CMD treatment,including limitations in diagnostic tools and the lack of personalized treatment strategies.Future research should focus on the complex interactions between CMD and metabolic risks,aiming to optimize diagnostic and therapeutic strate-gies to improve the long-term prognosis of patients post-PCI.

关 键 词：Coronary microvascular dysfunction Percutaneous coronary intervention Diagnosis Management Coronary flow reserve Microvascular resistance Stem cell therapy Adverse outcomes 

分 类 号：R54[医药卫生—心血管疾病]