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Myocardial Perfusion and Angina Improvement Following Allopurinol Therapy in a Patient With Coronary Artery Fistula

Sara D V Ziotti1, Renato P Azevedo2, Thiago L V Pereira3

  • 1Centro de Pesquisa Clinica Prof. Fulvio Pileggi, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil; Unidade de Prevencao, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil.

JACC. Case Reports
|August 15, 2025
PubMed

Insights

Coronary artery fistulas (CAFs) can cause angina. A high-dose allopurinol regimen improved symptoms and myocardial perfusion in a frail patient with CAFs unsuitable for intervention.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Coronary artery fistulas (CAFs) can cause myocardial ischemia and angina, even without obstructive coronary artery disease.
  • Currently, no noninterventional strategies are proven to improve symptoms or ischemia in patients with refractory angina due to CAFs.

Observation:

  • An 85-year-old woman with functional class 3 angina despite antianginal therapy presented with reversible left ventricular hypoperfusion.
  • Coronary angiography revealed a CAF but no obstructive coronary artery disease.

Findings:

  • The patient received high-dose allopurinol due to frailty and unsuitability for cardiac intervention.
  • This treatment led to significant improvements in angina symptoms, exercise capacity, and myocardial perfusion.

Implications:

  • Allopurinol may be a viable alternative treatment for ischemia and angina in patients with CAFs who are not candidates for traditional cardiac interventions.
  • This case suggests a potential role for allopurinol in managing refractory angina associated with CAFs.
Abstract

Keywords:
allopurinolcoronary artery fistulacoronary vessel anomaliesmyocardial ischemiamyocardial perfusionstable angina

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