Aortic Valve (TAVR/TAVI)JACCTuesday, July 14, 2026

Impact of Coronary Microvascular Dysfunction on Patient-Reported Symptoms After PCI.

1 min read·By E. Nolan Beckett, MD·Source: JACC. Advances

Key Numbers

71% male

37.3%

41% vs 34

P = 0.35

From The Valve Wire

The volume-outcome debate in TAVR just shifted from "get more reps" to "prevent the complication in the first place." The STS/ACC TVT Registry analysis of 487,159 patients across 808 US sites (2017–2023) found bottom-quartile centers had 12% higher 30-day mortality (aOR 1.12) and 19% higher major complication rates than top-quartile centers, but failure-to-rescue was flat at ~11% across all volume strata.

The editorial companion framed this as "complications, not rescue" — meaning the CMS volume threshold debate should focus on procedural technique, patient selection, and CT planning, not ICU heroics after things go wrong.

Editor’s take pending for this article; this is the section commentary excerpt.

Source Abstract

BACKGROUND: Coronary microvascular dysfunction (CMD) has been proposed as a mechanism underlying residual angina after percutaneous coronary intervention (PCI). OBJECTIVES: The objective of the study was to investigate the impact of CMD on symptoms in patients undergoing PCI. METHODS: Patients with hemodynamically significant coronary artery disease (CAD) (fractional flow reserve ≤0.80) were included. CAD was classified as focal or diffuse using the pull back pressure gradient (PPG) (diffuse CAD defined as PPG <0.62). CMD was defined as microvascular resistance reserve <3.0. The Seattle Angina Questionnaire (SAQ) was administered at baseline and 1 year. RESULTS: Among 201 patients (mean age 68.5 ± 10.1 years; 71% male), CMD was present in 75 (37.3%), with no difference between focal and diffuse CAD (41% vs 34%; P = 0.35). At baseline, CMD was associated with more severe symptoms without reaching statistical significance (SAQ summary score 64.0 ± 25.3 vs 69.6 ± 21.0; P = 0.09). At 1 year, symptoms were similar between groups (SAQ summary score 87.6 ± 16.0 vs 89.4 ± 16.4; P = 0.47). A significant interaction between PPG and microvascular resistance reserve was observed for residual angina (P for interaction = 0.015); patients with focal CAD and concomitant CMD had the highest burden of residual symptoms. CONCLUSIONS: CMD is present in approximately one-third of patients undergoing PCI and occurs with similar frequency in focal and diffuse CAD. CMD alone was not associated with residual angina. However, its clinical relevance varied according to the epicardial disease pattern: in focal CAD, concomitant CMD was associated with less symptomatic improvement after PCI, whereas in diffuse CAD, residual symptoms appeared to be driven predominantly by persistent epicardial disease.

Authors: Bouisset F, Ikeda K, Mizukami T, Munhoz D, Sonck J et al.

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