Unveiling the significance of coronary capillary circulation in coronary artery disease: insights from anatomy to pathophysiology

Abstract

Coronary artery disease is the leading cause of death in both men and women. Especially in women, myocardial infarction with non-obstructive coronary arteries (MINOCA) disproportionately affects this population and is increasingly evident. The central issue in MINOCA is the microcirculation, which is as crucial as its macro counterpart. Increased myocardial oxygen demand can be met through increased coronary blood flow or myocardial oxygen extraction. Capillary flow homogenization ensures effective myocardial oxygen extraction by facilitating the dilation of constricted capillary vessels in response to heightened metabolic demands. To maintain circulation, it is necessary to recruit non-functional capillaries. However, this recruitment can result in capillary transit time heterogeneity (CTH). Elevated CTH levels can diminish the myocardial metabolic rate of oxygen, resulting in a higher susceptibility to angina. Capillary vessels possess the ability to transform into collateral vessels within the ischemic heart condition. The formation, homogenization, and arterialization of the microcirculation play a critical role in the development of coronary artery disease.

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