Microvascular ischemia in patients with successful percutaneous coronary intervention: effects of ranolazine and isosorbide-5-mononitrate

Gaetano Antonio Lanza, Filippo Crea, Francesco Raffaele Spera, Laura Manfredonia, Antonio De Vita, Antonio Villano, Veronica Melita, Erica Mencarelli

Risultato della ricerca: Contributo in rivistaArticolo in rivista

6 Citazioni (Scopus)

Abstract

OBJECTIVE: About one-third of patients undergoing percutaneous coronary interventions (PCIs) for flow-limiting coronary stenosis continue to develop signs of myocardial ischemia (MI) during exercise stress test [EST], despite successful coronary revascularization. Coronary microvascular dysfunction is a likely major cause of the persistence of EST-induced MI in these patients.PATIENTS AND METHODS: We studied 15 patients (14 men, age 67 +/- 5 years) fulfilling the following strict inclusion criteria: (1) recent PCI (<6 months), with drug-eluting stent. of coronary artery stenoses for stable angina, with evidence of full success (no residual stenosis >20% in any vessel); (2) persistence of ST-segment depression induction during EST.After a basal investigation, patients received either ranolazine (375 mg bid) or isosorbide-5-mononitrate (ISMN, 20 mg bid) for 3 weeks in a single-blind, randomized crossover study. Clinical assessment, symptom-limited EST, echocardiographic color-Doppler. with tissue-Doppler examination, and coronary microvascular dilator response to adenosine (CFR-ADO) and cold pressor test (CFR-CPT), assessed by transthoracic echo-Doppler, were obtained at baseline and the end of the 3-week therapy with each drug.RESULTS: Compared to both baseline and ISMN, ranolazine showed a longer time to 1 mm ST-segment depression (404 +/- 116 s vs. 317 +/- 98 and 322 +/- 70 s, respectively; p<0.01). No differences were observed in coronary microvascular function and diastolic left ventricular function between the 2 drugs and compared to baseline.CONCLUSIONS: Our data show that ranolazine. but not ISMN, improved time to ischemia during EST. This effect, however, was independent of any effects on coronary microvascular and diastolic function.
Lingua originaleEnglish
pagine (da-a)6545-6550
Numero di pagine6
RivistaEuropean Review for Medical and Pharmacological Sciences
Volume22
DOI
Stato di pubblicazionePubblicato - 2018

Keywords

  • Microvascular circulation
  • Nitrates
  • Percutaneous coronary intervention
  • Ranolazine

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