Razavi Journal of Medicine

Razavi Journal of Medicine

Coronary Slow Flow Phenomenon: A Single-Center Analysis of Prevalence and Risk Factors

Document Type : Original Article

Authors
1 Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2 Department of Cardiology, Mashhad Medical Sciences Branch, Islamic Azad University, Mashhad, Iran
Abstract
Background: Coronary slow flow phenomenon (CSFP) is a syndrome characterized by delayed progression of the injected contrast through the epicardial coronary arteries, in the absence of significant stenosis. It is associated with myocardial ischemia, life-threatening arrhythmias, sudden cardiac death, and recurrent acute coronary syndromes.
 
Objective: This study aimed to determine the prevalence of CSFP and its risk factors.
 
Methods: This cross-sectional study was conducted on all patients undergoing diagnostic coronary angiography because of clinical suspicion of cardiovascular disease in Mashhad Ghaem Hospital from March 2019 to March 2020. The individual information checklist was completed, and the diagnosis of the CSFP was made on the basis of corrected TIMI frame count > 27 frames.
 
Results: In the present study, among 1112 patients undergoing coronary angiography, 7.5% had the criteria of CSFP. Statistical tests indicated a significant association between male sex and smoking (p-value < 0.05) with CSFP. The association between hypertension and CSFP was not significant in univariate analysis but became significant after adjustment. Factors such as age, diabetes mellitus, hyperlipidemia, and family history of heart disease had no significant difference between patients with and without CSFP.
 
Conclusion: Coronary slow flow phenomenon is not an uncommon finding during diagnostic coronary angiography. The observed associations with modifiable risk factors, particularly smoking and hypertension, suggest that attention to risk factor modification may be beneficial in patients with CSFP and should be considered in clinical practice.
Keywords

Acknowledgements: The authors would like to thank the staff of the Department of Cardiology at Ghaem Hospital, Mashhad, Iran, for their cooperation and assistance in conducting this study.

 

Availability of data and materials: The datasets are available from the corresponding author on reasonable request.

 

Conflicts of interests: The authors declare that they have no conflicts of interest regarding the publication of this article.

 

Consent for publication: Not applicable.

 

Ethics approval and consent to participate: The present study was approved by the Ethics Committee of Islamic Azad University of Mashhad (approval code: IR.IAU.MSHD.REC.1401.057). Written informed consent for publication was obtained from all participants. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.

 

Financial disclosure: This study received no specific financial support.

 

Author contributions: All authors contributed to the conception and design of the study. Nafise Lagzian and Fateme Alikhani performed data collection. Statistical analysis and interpretation of data were carried out by Morteza Manavifar. The manuscript was drafted by Nafise Lagzian and critically revised by Bahram Shahri. All authors read and approved the final version of the manuscript and agreed to its submission.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

1. Tambe A, Demany M, Zimmerman HA, Mascarenhas E. Angina pectoris and slow flow velocity of dye in coronary arteries-a new angiographic finding. American heart journal. 1972;84(1):66-71.
https://doi.org/10.1016/0002-8703(72)90307-9
PMid:5080284
 
2. Finley JJ, Savage MP. Coronary slow flow phenomenon: more than just an angiographic curiosity. Interventional Cardiology. 2012;4(3):337.
https://doi.org/10.2217/ica.12.23
 
3. Mehta HH, Morris M, Fischman DL, Finley JJ, Ruggiero N, Walinsky P, et al. The spontaneous coronary slow-flow phenomenon: reversal by intracoronary nicardipine. The Journal of Invasive Cardiology. 2018;31(3):42-5.
https://doi.org/10.25270/jic/18.00250
 
4. Beltrame JF, Limaye SB, Horowitz JD. The coronary slow flow phenomenon-a new coronary microvascular disorder. Cardiology. 2002;97(4):197-202.
https://doi.org/10.1159/000063121
PMid:12145474
 
5. Hawkins BM, Stavrakis S, Rousan TA, Abu-Fadel M, Schechter E. Coronary Slow Flow-Prevalence and Clinical Correlations-. Circulation Journal. 2012;76(4):936-42.
https://doi.org/10.1253/circj.CJ-11-0959
PMid:22293446
 
6. Yilmaz H, Demir I, Uyar Z. Clinical and coronary angiographic characteristics of patients with coronary slow flow. Acta cardiologica. 2008;63(5):579-84.
https://doi.org/10.2143/AC.63.5.2033224
PMid:19014000
 
7. Beltrame JF. Defining the coronary slow flow phenomenon. Circulation Journal. 2012;76(4):818-20.
https://doi.org/10.1253/circj.CJ-12-0205
PMid:22374148
 
8. Seyyed Mohammadzad MH, Khademvatani K, Gardeshkhah S, Sedokani A. Echocardiographic and laboratory findings in coronary slow flow phenomenon: cross-sectional study and review. BMC Cardiovascular Disorders. 2021;21(1):230.
https://doi.org/10.1186/s12872-021-02044-z
PMid:33952204 PMCid:PMC8097949
 
9. Javadi HR, Mirakbari SM, Allami A, Salavati E. Factors Determining Primary Coronary Slow Flow Phenomenon among Opium Users and Non-users: A Case Control Study in Northern Iran. Addict Health. 2022;14(3):224-8.
https://doi.org/10.34172/ahj.2022.1211
PMid:36544982 PMCid:PMC9743821
 
10. Diver DJ, Bier JD, Ferreira PE, Sharaf BL, McCabe C, Thompson B, et al. Clinical and arteriographic characterization of patients with unstable angina without critical coronary arterial narrowing (from the TIMI-IIIA Trial). The American journal of cardiology. 1994;74(6):531-7.
https://doi.org/10.1016/0002-9149(94)90739-0
PMid:8074033
 
11. Fineschi M, Gori T. Coronary slow flow: description of a new "cardiac Y" syndrome. International journal of cardiology. 2009;137(3):308-10.
https://doi.org/10.1016/j.ijcard.2008.05.076
PMid:18701173
 
12. Gupta MD, Akkarappatty C, Girish MP, Kumar R, Rain M, Tyagi S, et al. Association between the Glu298Asp and 4b/4a polymorphisms of endothelial nitric oxide synthase and coronary slow flow in the North Indian population. Coronary artery disease. 2014;25(3):192-7.
https://doi.org/10.1097/MCA.0000000000000093
PMid:24525787
 
13. Özen K, Karahan MZ, Karahan MZ. Non-dipper blood pressure impact on coronary slow flow in hypertensive patients with normal coronary arteries. Cureus. 2023;15(1).
https://doi.org/10.7759/cureus.33356
 
14. Tanriverdi H, Evrengul H, Kuru O, Tanriverdi S, Seleci D, Enli Y, et al. Cigarette smoking induced oxidative stress may impair endothelial function and coronary blood flow in angiographically normal coronary arteries. Circulation Journal. 2006;70(5):593-9.
https://doi.org/10.1253/circj.70.593
PMid:16636496
 
15. Saya S, Hennebry TA, Lozano P, Lazzara R, Schechter E. Coronary slow flow phenomenon and risk for sudden cardiac death due to ventricular arrhythmias: a case report and review of literature. Clinical Cardiology: An International Indexed and Peer‐Reviewed Journal for Advances in the Treatment of Cardiovascular Disease. 2008;31(8):352-5
https://doi.org/10.1002/clc.20266
PMid:17957738 PMCid:PMC6653277