Coronary Microvascular Disease after Myocardial Infarction: Diagnostic Approach and Prognostic Value—A Narrative Review

Coronary microvascular disease (CMVD) is not an uncommon complication after acute myocardial infarction (AMI), independent of prompt revascularization. It is a serious yet underdiagnosed disease that has a major impact on patient’s outcomes. Even when the infarct-related artery is successfully revascularized, a significant per-centage of patients still have compromised microvascular circulation, which is linked to higher cardiovascular mortality and hospitalization for heart failure. The well-known invasive methods, such as the index of microvascular resistance (IMR), and the coronary flow reserve (CFR) have been considered as gold standards. Howev-er, they are constrained by their hazards and complexity. Non-invasive techniques, such as the echocardiography doppler for CFR assessment, the positron emission to-mography (PET) and cardiac magnetic resonance imaging (CMR) and some other techniques provide alternatives, but their accessibility, the cost and their implementa-tion during the peri-AMI period raise obstacles for their wide use. This review high-lights both invasive and non-invasive modalities as it examines the diagnostic meth-ods and prognostic significance of CMVD in patients who have had an AMI. Enhanc-ing long-term results in this high-risk population requires an understanding of and commitment to CMVD.