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The angiographic and clinical benefits of mibefradil in the coronary slow flow phenomenon

John F. Beltrame, BSc, BMBS, FRACP, PhD, FESC, FACC^*,*, Stuart P. Turner, BMed, FRACP^*, Sue L. Leslie, RN^*, Patty Solomon, BSc, Dip Maths Stats, PhD, Saul B. Freedman, MBBS, FRACP, PhD, FACC and John D. Horowitz, MBBS, BMed Sci, PhD, FRACP^*

^* Cardiology Unit, North Western Adelaide Health Service, University of Adelaide, Adelaide, Australia
School of Applied Mathematics and ARC Special Research Centre for Molecular Genetics of Development, University of Adelaide, Adelaide, Australia
Department of Cardiology, Concord Repatriation General Hospital, and Anzac Research Institute, University of Sydney, Sydney, Australia

View larger version (12K): [in a new window]   Figure 1 Study protocol. Summary of the 12-week study protocol including double-blind randomization to placebo/mibefradil 50 mg therapy for one week followed by four weeks of placebo/mibefradil 100 mg therapy with cross-over to the alternative therapy after a one-week washout period.

View larger version (90K): [in a new window]   Figure 2 Acute angiographic response to mibefradil. An example of the angiographic response to a single oral dose of 50 mg mibefradil in a patient with the coronary slow flow phenomenon (CSFP). The angiographic snapshots presented were taken exactly three heart beats after contrast filled the width of the left main coronary artery. (A) Recorded before mibefradil administration and demonstrates incomplete opacification of the left anterior descending and circumflex arteries at three beats, thereby confirming the diagnosis of the CSFP. (B) Demonstrates improved vessel opacification 30 min after mibefradil administration.

View larger version (25K): [in a new window]   Figure 3 Profile plot of angiographic response to mibefradil. The Thrombolysis In Myocardial Infarction (TIMI) frame counts were assessed by two blinded independent observers immediately before and 30 min after a single oral 50 mg mibefradil dose in 10 patients with the coronary slow flow phenomenon (CSFP). Mibefradil selectively improved the angiographic response in the 18 vessels initially exhibiting the CSFP (A) (p < 0.005) and had little effect in the 12 vessels with TIMI-3 flow (B).