Systemic inflammatory disorders including psoriasis, SLE, rheumatoid arthritis and possible others increase the frequency of impaired coronary vasodilator function, resulting from an increased burden of diffuse atherosclerosis in conduit vessels and coronary microvascular dysfunction. In this study, we observed that the lowest myocardial flow reserve tertile (MFR < 1.65) had worse adjusted overall survival and worse adjusted cardiovascular event-free survival in patients with systemic inflammatory disease (SLE, RA, psoriasis).