Slow coronary run-off in patients with angina pectoris: clinical significance and thallium-201 scintigraphic study

To determine whether or not slow coronary flow (SF) depends on hemodynamic variables, we studied 17 patients (15 men, mean age = 47.8 years) with SF at coronariography. Exercise thallium-201 myocardial scintigraphy revealed perfusion abnormalities in 13 (76.4 per cent) patients. We then selected 89 individuais submitted to cinecoronariography for comparison: 15 were normal and 74 had heart disease. The coronary flow velocity was evaluated by the number of heart beats (HB) needed for coronary artery dye filling. The patients in the SF group had normal hemodynamic variables which were significantly different from those of patients with heart disease (P = 0.001). Patients with heart disease needed no more than 4 HB to fill their arteries, in contrast to 6.88 ñ 1.68 (5 to 11) in the SF group (P<0.OOO1). Thus, in our patients with myocardial scintigraphy suggesting ischemia, SF was found to be an event which did not depend on hemodynamic factors.

Beneficial effect of long-term use of a beta-blocker in patients before acute myocardial infarction

The outcome of 38 beta-blocker users (group BB, 28 men and 10 women with a mean age of 56 ñ 4 years) was compared to that of 100 non-users (group NU, 69 men and 31 women with mean age of 57 ñ 8 years) after acute myocardial infarction (AMI). The two groups were compared in terms of electrocardiographic (EKG) location of the AMI (anterior, inferior and lateral), EKG Q and non-Q wave infarction, clincial functional class of Forrester, serum cratine phosphokinase MB fraction (CKMB) peak release and intrahospital mortality.There were no differences between groups concerning sex or severity of coronary artery disease bath arterial hypertension was 3-fold more prevalent group BB. The EKG location of the AMI was similar int he two groups. Non-Q infarction was significantly more prevalent in group BB (37 percent) than in group NU (5 percent). The incidence of clinical functional class IV of Forrester and the serum CKMB peaks were significantly lower in goup BB (2.6 percent vs 16.0 percent and 53 ñ 3 vs 68 ñ 9 UI/1, respectively. Intrahospital mortality was also significantly lower in group BB (2.6 percent) than in group NU (10 percent). These data suggest the beneficial effect of previous long-term use of beta-blockers as indicated by a lower incidence of cardiogenic shock and a significant decrease in intrahospital mortality after AMI