Acute effects of isosorbide dinitrate and nicorandil on the coronary slow flow phenomenon.
BACKGROUND
Microvascular dysfunction has been proposed as the most likely mechanism of the coronary slow flow phenomenon (CSFP).


OBJECTIVE
To determine the effects of isosorbide dinitrate and nicorandil on the CSFP.


METHODS
Changes in thrombolysis in myocardial infarction (TIMI) frame count following the intracoronary administration of isosorbide dinitrate and nicorandil were assessed in 11 patients with the CSFP.


RESULTS
After the administration of isosorbide dinitrate, the median TIMI frame count decreased to 32 (range 20-60) [p = 0.003], which was lower than that of the control [43 (29-73)]. The count decreased further to 25 (12-34) [p = 0.041] after the administration of nicorandil. The count after the subsequent administration of contrast medium was increased to 32 (20-49) [p = 0.03].


CONCLUSIONS
These angiographic findings indicate that the intracoronary administration of nicorandil is superior to isosorbide dinitrate with regard to improving the CSFP. These findings suggest that microvascular spasm is the main factor in the pathogenesis of the CSFP.
Sadamatsu
Kenji
K
Department of Cardiology, Saga Prefectural Hospital Koseikan, Saga, Japan. k-sadamatsu@umin.ac.jp
Tashiro
Hideki
H
Yoshida
Keiki
K
Shikada
Tomoki
T
Iwamoto
Kenso
K
Morishige
Kunio
K
Yoshidomi
Yuya
Y
Tokunou
Tomotake
T
Tanaka
Haruki
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects; D005260:Female; D006801:Humans; D007548:Isosorbide Dinitrate / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D020108:Nicorandil / Q000627:therapeutic use*; D054318:No-Reflow Phenomenon / Q000188:drug therapy*; D011446:Prospective Studies; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014665:Vasodilator Agents; D020108:Nicorandil; D007548:Isosorbide Dinitrate