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

Core Tip

Core Tip: Coronary microvascular dysfunction (CMD) is a significant cause of persistent myocardial ischemia in patients following percutaneous coronary intervention. This review highlights the complex pathophysiology of CMD, which involves endothelial dysfunction, microvascular remodeling, reperfusion injury, and metabolic abnormalities. The interplay between CMD and metabolic syndrome exacerbates microcirculatory dysfunction through inflammation, oxidative stress, and insulin resistance. Advances in diagnostic techniques, including invasive methods like coronary flow reserve and index of microcirculatory resistance, and non-invasive imaging such as positron emission tomography and cardiac magnetic resonance, have improved early detection. Management strategies emphasize a multi-level approach combining lifestyle interventions, pharmacological therapies, and specialized treatments like enhanced external counterpulsation and metabolic surgery. Future research should focus on optimizing diagnostic tools, developing precision therapies, and understanding the genetic and molecular basis of CMD to improve long-term patient outcomes.