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CLINICAL STUDY: CORONARY ARTERY DISEASE

Absolute quantitation of coronary steal induced by intravenous dipyridamole

Olakunle O. Akinboboye, MD, MPH, FACC^*, Olajide Idris, MD, Ru-Ling Chou, PhD, Robert R. Sciacca, EngScD, Paul J. Cannon, MD, FACC and Steven R. Bergmann, MD, PhD, FACC

^* Nuclear Cardiology Laboratory, St. Francis Hospital, Roslyn, New York, USA
Division of Cardiology, College of Physicians and Surgeons of Columbia University, New York, New York, USA

Manuscript received April 14, 2000; revised manuscript received July 12, 2000, accepted September 7, 2000.

Reprint requests and correspondence: Dr. Olakunle O. Akinboboye, Nuclear Cardiology Laboratory, St. Francis Hospital, 100 Port Washington Blvd., Roslyn, New York 11576

OBJECTIVES

The study was done to determine whether coronary steal (defined as an absolute decrease in perfusion from resting blood flow) is induced by intravenous (IV) dipyridamole in patients with severe coronary artery disease (CAD).

BACKGROUND

Myocardial ischemia during coronary vasodilation is usually attributed to coronary steal. However, there is limited data on the absolute magnitude of coronary steal in humans.

METHODS

Eighteen patients with multivessel CAD underwent dynamic positron emission tomography (PET) imaging with ¹³NH₃ at rest and after infusion of IV dipyridamole. Eight myocardial sectors were analyzed per short axis slice and myocardial blood flow calculated with a two-compartment model in absolute terms.

RESULTS

Coronary steal occurred in 8 of the 18 patients. In the 8 patients with coronary steal, myocardial blood flow decreased from 90 ± 18 ml/100 g/min at rest to 68 ± 27 ml/100 g/min following dipyridamole in the segments with steal, and increased from 87 ± 19 to 138 ± 16 ml/100 g/min following dipyridamole in the segments without steal. Significant clinical correlates of coronary steal were either ST elevation or the combination of ST depression and angina.

CONCLUSIONS

Coronary vasodilation with IV dipyridamole is associated with significant reductions in blood flow to collateral-dependent myocardium consistent with coronary steal in about 45% of patients with severe CAD.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   BP = blood pressure   CABG = coronary artery bypass grafting   CAD = coronary artery disease   LAD = left anterior descending artery   LCx = left circumflex artery   MBF = myocardial blood flow   13N = nitrogen-13   NH3 = ammonia   PET = positron emission tomography   RCA = right coronary artery

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