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Intracoronary administration of nicorandil for the treatment of spontaneous microvascular spasm with ST segment

Kurisu Satoshi1, Inoue Ichiro, Kawagoe Takuji

  • 1Division of Cardiology, Hiroshima City Hospital, Japan. skurisu@nifty.com

Circulation Journal : Official Journal of the Japanese Circulation Society
|March 3, 2004
PubMed

Insights

Recurrent chest pain in a patient without significant coronary stenosis was diagnosed as angina pectoris with ST segment elevation. This was caused by microvascular spasm, effectively treated with nicorandil.

Area of Science:

  • Cardiology
  • Vascular Medicine

Background:

  • A 64-year-old male presented with recurrent rest angina.
  • Previous coronary intervention of the left anterior descending artery.
  • Coronary angiography showed no significant stenosis.

Purpose of the Study:

  • To investigate the cause of ST-segment elevation angina in a patient with non-obstructive coronary artery disease.
  • To evaluate the efficacy of intracoronary nicorandil in managing microvascular spasm.

Main Methods:

  • Coronary angiography to assess coronary arteries.
  • Intracoronary administration of nicorandil during angiography.
  • Electrocardiogram monitoring for ST-segment changes.

Main Results:

  • Chest pain and ST-segment elevation occurred during right coronary angiography.
  • No significant coronary stenosis was found, but contrast washout was markedly delayed.
  • Intracoronary nicorandil administration attenuated the delayed washout and symptoms.

Conclusions:

  • The patient was diagnosed with angina pectoris caused by microvascular spasm with ST segment elevation.
  • Microvascular dysfunction should be considered in patients with angina and non-obstructive coronary arteries.
  • Nicorandil demonstrated effectiveness in managing this specific type of angina.

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