Peripheral microvascular function and in-stent late lumen loss after percutaneous coronary intervention: a retrospective cohort study with an exploratory analysis by implanted stent diameter
- 1Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine
- 2Cardiovascular Center, Seoul National University Boramae Medical Center
Abstract
Introduction: Peripheral microvascular endothelial function measured by the reactive hyperemia index (RHI) with EndoPAT predicts cardiovascular outcomes, and post-procedural RHI has been associated with binary in-stent restenosis. Whether pre-procedural RHI relates to in-stent late lumen loss (LLL) measured by quantitative coronary angiography (QCA) after percutaneous coronary intervention (PCI), and whether any association depends on device caliber, has not been established.
Methods: We retrospectively analyzed 132 patients who underwent EndoPAT before PCI (index PCI 2009-2016). The primary endpoint was in-stent LLL at follow-up angiography ( n = 91; median follow-up 9.4 months). Because in-stent LLL was highly skewed, the primary analysis used Spearman correlation and a robust (HC3) multivariable regression adjusting for age, diabetes, hypertension, number of diseased vessels, and pre-PCI minimal lumen diameter. Pre-specified sensitivity analyses included multiple imputation (MICE, m = 20) for missing follow-up and lesion-level generalized estimating equations (GEE). Subgroup analyses by implanted stent diameter (≤2.75 versus >2.75 mm) and diabetes were exploratory.
Results: RHI showed only a borderline inverse correlation with in-stent LLL ( ρ = −0.19, p = 0.07) and was not independently associated with it (adjusted β = −0.11, 95% CI −0.39 to +0.18, p = 0.45); multiple imputation ( β = −0.08) and GEE ( β = −0.07) were concordant, and no correlation survived false-discovery-rate correction. Stratification by native reference vessel diameter showed no association, whereas stratification by implanted stent diameter revealed an inverse RHI–LLL correlation confined to small-diameter stents (≤2.75 mm, n = 33; ρ = −0.375, p = 0.032) but not larger stents ( ρ = −0.055). However, the stent-diameter × RHI interaction was not significant ( p = 0.48), so this caliber-dependent signal is hypothesis-generating and tracks the achieved implanted caliber rather than the native reference vessel. Inflammation explained neither result. High-sensitivity C-reactive protein (hs-CRP) was unrelated to RHI ( ρ = −0.02) and to in-stent LLL ( ρ = +0.15), and adding it to the primary model left the RHI estimate unchanged. Small-caliber recipients had similar hs-CRP but more diabetes (57.6% versus 27.6%, p = 0.009) and worse renal function ( p = 0.008), indicating a higher-risk phenotype rather than a pure caliber stratum.
Discussion: Pre-procedural EndoPAT RHI was not independently associated with in-stent LLL. The exploratory signal confined to small-caliber stents is hypothesis-generating and requires prospective, device-caliber-stratified validation pairing pre- with post-procedural RHI.
Related
- The impact of the SYNTAX score on the incidence of in-hospital cardiac arrest in patients with acute coronary syndrome undergoing percutaneous coronary intervention: a retrospective cohort study
- Residual SYNTAX score and optical coherence tomography–derived thin-cap fibroatheroma in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention: an exploratory descriptive pilot study
- Impact of a Continuous Quality Improvement Committee on Outcomes for Patients Undergoing Percutaneous Coronary Intervention: A Single-Center Retrospective Cohort Study
- Nomogram for predicting post-percutaneous coronary intervention restenosis in patients with coronary artery disease and diabetes: a retrospective study
- The baseline predictive value of the RNA-binding proteins IGF2BP3/IMP3 and UPF1 for in-stent restenosis after percutaneous coronary intervention in acute coronary syndrome: a retrospective cohort study
BibTeX
@article{kim2026peripheral,
title = {{Peripheral microvascular function and in-stent late lumen loss after percutaneous coronary intervention: a retrospective cohort study with an exploratory analysis by implanted stent diameter}},
author = {Hangyeol Kim and Hyun Sung Joh and Woo-Hyun Lim and Hack-Lyoung Kim and Sang-Hyun Kim and Jae-Bin Seo},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1940897},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1940897/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Peripheral microvascular function and in-stent late lumen loss after percutaneous coronary intervention: a retrospective cohort study with an exploratory analysis by implanted stent diameter
AU - Hangyeol Kim
AU - Hyun Sung Joh
AU - Woo-Hyun Lim
AU - Hack-Lyoung Kim
AU - Sang-Hyun Kim
AU - Jae-Bin Seo
PY - 2026
DA - 2026/10/27
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1940897
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1940897/full
AB - Introduction: Peripheral microvascular endothelial function measured by the reactive hyperemia index (RHI) with EndoPAT predicts cardiovascular outcomes, and post-procedural RHI has been associated with binary in-stent restenosis. Whether pre-procedural RHI relates to in-stent late lumen loss (LLL) measured by quantitative coronary angiography (QCA) after percutaneous coronary intervention (PCI), and whether any association depends on device caliber, has not been established. Methods: We retrospectively analyzed 132 patients who underwent EndoPAT before PCI (index PCI 2009-2016). The primary endpoint was in-stent LLL at follow-up angiography ( n = 91; median follow-up 9.4 months). Because in-stent LLL was highly skewed, the primary analysis used Spearman correlation and a robust (HC3) multivariable regression adjusting for age, diabetes, hypertension, number of diseased vessels, and pre-PCI minimal lumen diameter. Pre-specified sensitivity analyses included multiple imputation (MICE, m = 20) for missing follow-up and lesion-level generalized estimating equations (GEE). Subgroup analyses by implanted stent diameter (≤2.75 versus >2.75 mm) and diabetes were exploratory. Results: RHI showed only a borderline inverse correlation with in-stent LLL ( ρ = −0.19, p = 0.07) and was not independently associated with it (adjusted β = −0.11, 95% CI −0.39 to +0.18, p = 0.45); multiple imputation ( β = −0.08) and GEE ( β = −0.07) were concordant, and no correlation survived false-discovery-rate correction. Stratification by native reference vessel diameter showed no association, whereas stratification by implanted stent diameter revealed an inverse RHI–LLL correlation confined to small-diameter stents (≤2.75 mm, n = 33; ρ = −0.375, p = 0.032) but not larger stents ( ρ = −0.055). However, the stent-diameter × RHI interaction was not significant ( p = 0.48), so this caliber-dependent signal is hypothesis-generating and tracks the achieved implanted caliber rather than the native reference vessel. Inflammation explained neither result. High-sensitivity C-reactive protein (hs-CRP) was unrelated to RHI ( ρ = −0.02) and to in-stent LLL ( ρ = +0.15), and adding it to the primary model left the RHI estimate unchanged. Small-caliber recipients had similar hs-CRP but more diabetes (57.6% versus 27.6%, p = 0.009) and worse renal function ( p = 0.008), indicating a higher-risk phenotype rather than a pure caliber stratum. Discussion: Pre-procedural EndoPAT RHI was not independently associated with in-stent LLL. The exploratory signal confined to small-caliber stents is hypothesis-generating and requires prospective, device-caliber-stratified validation pairing pre- with post-procedural RHI.
SN - 2297-055X
ER -