Abstract 17088: Use of Intracoronary Nicardipine to Reverse Spontaneous Coronary Slow Flow

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Introduction: An under-recognized cause of chest pain and acute coronary syndromes, the coronary slow flow (CSF) phenomenon is characterized by delayed coronary opacification during diagnostic angiography in the absence of obstructive coronary artery disease (CAD). Given its angiographic resemblance to no-reflow during percutaneous coronary intervention (PCI), a condition associated with microvascular spasm which is responsive to calcium channel blockers, we hypothesized that spontaneous CSF may similarly be reversed by intracoronary (IC) nicardipine.

Methods: The effect of IC nicardipine on CSF was retrospectively assessed in 30 consecutive patients. CSF was defined as spontaneously delayed flow (

Results: The study population consisted of 22 men and 8 women with a mean age of 54±11 years. The clinical presentation was rest angina in 21 (70%) patients. At baseline, CSF with 27) in 68/90 (76%) epicardial vessels. IC nicardipine produced markedly accelerated coronary filling, which was corroborated by TFC analysis. TFC was 52±17 before versus 15±5 after nicardipine (Figure) (p<0.0001). All vessels demonstrated TIMI 3 flow and TFC<28 after nicardipine.

Conclusion: Intracoronary nicardipine appears highly effective in reversing spontaneous CSF and implicates microvascular spasm in its pathogenesis. Further studies assessing the role of oral calcium channel blockers in the management of symptomatic patients with CSF are needed.

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