News | Cath Lab | December 27, 2018

Study Finds Effective Treatment for Coronary Slow Flow

Researchers find effective way to treat underdiagnosed condition that can cause heart attack and heart-attack-like symptoms.

Study Finds Effective Treatment for Coronary Slow Flow

December 27, 2018 — Patients who arrive at the hospital with heart-attack-like symptoms have had little recourse for their chest pain if scans came back clear, with no signs of blocked coronary arteries. Some of these cases are caused by a little-known phenomenon called coronary slow flow. Now, researchers at Jefferson (Philadelphia University + Thomas Jefferson University), have demonstrated for the first time a simple technique to effectively treat this under-recognized condition. They published their findings in the Journal of Invasive Cardiology on Dec. 15.1

“One of the biggest issues with coronary slow flow is that many cardiologists aren’t familiar with it and don’t know what to look for to diagnose it,” said senior author Michael Savage, M.D., director of the cardiac catheterization lab at the Sidney Kimmel Medical College at Thomas Jefferson University. “Here we’ve shown that once you do recognize it, the condition can be treated with an existing and safe medical intervention that reverses the problem.”

Not a lot is known about the coronary slow flow. It is identified by angiogram of the heart, revealing arteries that fill with blood more slowly than normal, even in the absence of fatty plaque deposits. But what causes the condition, and why in 80 percent of cases patients experience additional episodes of chest pain, is still unknown. One association that can be drawn, said first author Hetal H. Mehta, M.D., a cardiology fellow at Jefferson, is that smokers are two-to-three times more likely to experience the phenomenon.

When Savage and others first saw the condition on angiograms of their patients, it appeared similar to the no-reflow phenomenon caused by microvascular spasm during coronary angioplasty procedures. Since that condition could be treated with a drug called nicardipine, Savage and colleagues decided to test it with their coronary slow flow patients. “It worked incredibly well,” he said.

In this study, the researchers analyzed the data and outcomes of 30 patients with coronary slow flow who were treated during cardiac catheterization with an intracoronary injection of nicardipine. They found a total of 49 blood vessels with slow blood flow. After treatment with nicardipine, all of the vessels showed normalized blood flow.

“These results suggest that microvascular spasm may be responsible for this condition, which can be effectively reversed with a calcium channel blocker like nicardipine,” said Savage. “It’s a simple intervention that takes only a few seconds to administer, and helps diagnose the condition and treat it at the same time.”

Nicardipine appears to reverse the condition in the short term, but future studies are needed to explore whether the one-time treatment reverses the condition permanently, or whether patients would benefit from long-term use of an oral calcium channel blocker.

The authors report no conflicts of interest.

For more information: www.invasivecardiology.com

Reference

1. Mehta H.H., Morris M., Fischman D.L., et al. The Spontaneous Coronary Slow-Flow Phenomenon: Reversal by Intracoronary Nicardipine. Journal of Invasive Cardiology, Dec. 15, 2018.

Related Content

Philips Launches Azurion With FlexArm
Technology | Angiography | January 17, 2019
Philips announced the launch of Azurion with FlexArm, designed to enhance positioning flexibility for image-guided...
Videos | Angiography | December 12, 2018
This is a quick walk around of a GE Healthcare Image Guided System (IGS) angiography system cath lab room display at
Shimadzu Medical Systems Teams With Change Healthcare Cardiology
News | Angiography | October 17, 2018
Shimadzu Medical Systems USA and Change Healthcare have entered a partnership through which Shimadzu will offer Change...
Osprey Medical and GE Healthcare Launch Acute Kidney Injury Educational Program
News | Angiography | September 21, 2018
Osprey Medical announced a collaboration with GE Healthcare on Osprey’s Be Kind to Kidneys campaign. The campaign aims...
How to reduce radiation exposure in the cath lab fluoroscopy. Imaging system in photo is a Philips XperFlex.
Feature | Angiography | June 06, 2018 | Dave Fornell, Editor
June 6, 2018 — Here is a checklist of dose-sparing practices for angiographic X-ray imaging used in the cath lab.
Philips Azurion angiography system, image-guided therapy system.

The Philips Azurion angiography system offers several imaging and software enhancements to aid guidance during complex interventional procedures.

Feature | Angiography | February 07, 2018 | Dave Fornell
Five new angiography systems were launched in 2017 that included improvements to speed workflow and improve both imag
Philips Azurion Platform Improves Clinical Workflow and Staff Experience Benefits
News | Angiography | December 04, 2017
Philips recently announced the results of a comprehensive, independent, two-year study demonstrating the clinical...
Videos | Angiography | November 22, 2017
Shimadzu demonstrated its Trinias Interventional X-ray System at the 2017 Transcatheter Cardiovascular Therapeutics (
Philips Azurion Image-Guided Therapy Platform Improves Clinical Workflow for Interventional Procedures
News | Angiography | November 15, 2017
Philips announced the results of a comprehensive, independent, two-year study demonstrating the clinical workflow...
Mississippi Surgical and Vascular Center Uses Toshiba Ultimax-i FPD to Save Patients' Limbs
News | Angiography | September 14, 2017
The southern U.S. sees some of the highest numbers of chronic medical conditions, such as peripheral artery disease...
Overlay Init