Original Research Article

American Journal of Cardiovascular Drugs

, Volume 10, Issue 3, pp 203-208

First online:

Acute Effects of Isosorbide Dinitrate and Nicorandil on the Coronary Slow Flow Phenomenon

  • Kenji SadamatsuAffiliated withDepartment of Cardiology, Saga Prefectural Hospital KoseikanDepartment of Cardiology, St Mary’s Hospital Email author 
  • , Hideki TashiroAffiliated withDepartment of Cardiology, St Mary’s Hospital
  • , Keiki YoshidaAffiliated withDepartment of Cardiology, Saga Prefectural Hospital Koseikan
  • , Tomoki ShikadaAffiliated withDepartment of Cardiology, St Mary’s Hospital
  • , Kenso IwamotoAffiliated withDepartment of Cardiology, St Mary’s Hospital
  • , Kunio MorishigeAffiliated withDepartment of Cardiology, St Mary’s Hospital
  • , Yuya YoshidomiAffiliated withDepartment of Cardiology, Saga Prefectural Hospital Koseikan
  • , Tomotake TokunouAffiliated withDepartment of Cardiology, Saga Prefectural Hospital Koseikan
  • , Haruki TanakaAffiliated withDepartment of Cardiology, Saga Prefectural Hospital Koseikan

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Abstract

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 micro-vascular spasm is the main factor in the pathogenesis of the CSFP.