The coronary slow flow phenomenon is an angiographic finding characterized by delayed distal vessel opacification in the absence of significant epicardial coronary disease. Case-control and observational studies of patients with this phenomenon were conducted to determine the associated clinical features and prognosis. Patients with coronary slow flow (n = 47) differed from controls (n = 47), more often being current smokers (32 vs. 9%; p < 0.01) and presenting with rest pain requiring urgent admission (74 vs. 21%; p < 0.001), usually to the coronary care unit (66 vs. 17%; p < 0.01). During a median 21-month follow-up of 64 slow flow patients, 84% had recurrent chest pain. Based upon these findings and those of previous investigators, it is speculated that coronary slow flow is a new disease entity characterized by acute but recurrent perturbations of microvascular function.

Keywords:
Angiography, Syndrome X, Microcirculation, Unstable angina
1.
Mosseri M, Yarom R, Gotsman MS, Hasin Y: Histologic evidence for small-vessel coronary artery disease in patients with angina and patent large coronary arteries. Circulation 1986;74:964–972.
2.
Mangieri E, Macchiarelli G, Ciavolella M, Barilla F, Avella A, Martinotti A, Dell’Italia LJ, Scibilia G, Motta P, Campa PP: Slow coronary flow: Clinical and histopathological features in patients with otherwise normal epicardial coronary arteries. Cathet Cardiovasc Diagn 1996;37:375–381.
3.
Chesebro J, Knatterud G, Roberts R, Borer J, Cohen L, Dalen J, Dodge H, Francis C, Hillis D, Ludbrook P, Markis J, Mueller H, Passamani E, Powers E, Rao A, Robertson T, Ross A, Ryan T, Sobel B, Willerson J, Williams D, Zaret B, Braunwald E: Thrombolysis in Myocardial Infarction (TIMI) Trial, Phase I: A comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge. Circulation 1987;76:142–154.
4.
Gibson CM, Cannon CP, Daley WL, Dodge JTJ, Alexander BJ, Marble SJ, McCabe CH, Raymond L, Fortin T, Poole WK, Braunwald E: TIMI frame count: A quantitative method of assessing coronary artery flow. Circulation 1996;93:879–888.
5.
Uehata A, Matsuguchi T, Bittl J, Orav J, Meredith I, Anderson T, Selwyn A, Ganz P, Yeung A: Accuracy of electronic digital calipers compared with quantitative angiography in measuring coronary arterial diameter. Circulation 1993;88:1724–1729.
6.
Nava Lopez G, Monteverde C, Jauregui R, del Rio A, Velez M, Ponce L, de la Llata M: X syndrome. Angiographic findings. Arch Inst Cardiol Méx 1989;59:257–265.
7.
Przybojewski J, Becker P: Angina pectoris and acute myocardial infarction due to ‘slow-flow phenomenon’ in non-atherosclerotic coronary arteries: A case report. Angiology 1986;37:751–761.
8.
Diver D, Bier J, Ferreira P, Sharaf B, McCabe C, Thompson B, Chaitman B, Williams D, Braunwald E: Clinical and arteriographic characterization of patients with unstable angina without critical coronary arterial narrowing (from the TIMI-IIIA trial). Am J Cardiol 1994;74:531–537.
9.
Kahn JK: Slow coronary flow complicating elective balloon angioplasty in postthrombolytic patients. Coron Artery Dis 1993;4:61–65.
10.
Ishizaka N, Issiki T, Saeki F, Furuta Y, Ikari Y, Yamaguchi T: Predictors of myocardial infarction after distal embolization of coronary vessels with percutaneous transluminal coronary angioplasty. Experience of 21 consecutive patients with distal embolization. Cardiology 1994;84:298–304.
11.
Nakamura M, Tsunoda T, Wakatsuki T, Ui K, Degawa T, Yabuki S, Yamaguchi T: Distal coronary flow velocity immediately after direct angioplasty for acute myocardial infarction. Am Heart J 1996;132:251–257.
12.
Wilson RF, Lesser JR, Laxson DD, White CW: Intense microvascular constriction after angioplasty of acute thrombotic coronary arterial lesions. Lancet 1989;i:807–811.
13.
White C: Simplicity’s virtue scorned. Precision comes to TIMI flow grading and the results are ... surprising. Circulation 1996;93:853–856.
14.
Voelker W, Euchner U, Dittmann H, Karsch KR: Long-term clinical course of patients with angina and angiographically normal coronary arteries. Clin Cardiol 1991;14:307–311.
15.
Chambers J, Bass C: Chest pain with normal coronary anatomy: A review of natural history and possible aetiological factors. Prog Cardiovasc Dis 1990;33:161–184.
16.
Tambe AA, Demany MA, Zimmerman HA, Mascarenhas E: Angina pectoris and slow flow velocity of dye in coronary arteries: A new angiographic finding. Am Heart J 1972;84:66–71.
17.
Murakami H, Urabe K, Nishimura M: Inappropriate microvascular constriction produced transient ST-segment elevation in patients with syndrome X. J Am Coll Cardiol 1998;32:1287–1294.
18.
Beltrame JF, Horowitz JD: ST elevation secondary to microvascular dysfunction. J Am Coll Cardiol 1999;34:312–313.
19.
Larkin SW, Clarke JG, Keogh BE, Araujo L, Rhodes C, Davies GJ, Taylor KM, Maseri A: Intracoronary endothelin induces myocardial ischemia by small vessel constriction in the dog. Am J Cardiol 1989;64:956–958.
20.
Clarke J, Davies G, Kerwin R, Hackett D, Larkin S, Dawbarn D, Lee Y, Bloom S, Yacoub M, Maseri A: Coronary artery infusion of neuropeptide Y in patients with angina pectoris. Lancet 1987;i:1057–1059.
21.
Kaski JC, Rosano GM, Collins P, Nihoyannopoulos P, Maseri A, Poole-Wilson PA: Cardiac syndrome X: Clinical characteristics and left ventricular function. Long-term follow-up study. J Am Coll Cardiol 1995;25:807–814.
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2002
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