{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:53:57Z","timestamp":1753890837814,"version":"3.41.2"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T00:00:00Z","timestamp":1662595200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The optimum therapy for coronary slow flow phenomenon (CSFP) stays debatable. This study compared the effectiveness of alprostadil with isosorbide dinitrate in alleviating angina episodes in CSFP patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this prospective, randomized controlled study, 102 patients with CSFP without severe coronary artery stenosis that exhibited stable angina were allocated randomly in a ratio of 1:1 to either the alprostadil group (40 \u03bcg, three times per day, <jats:italic>n<\/jats:italic> = 51) or the isosorbide dinitrate group (5 mg, three times per day, <jats:italic>n<\/jats:italic> = 51). Frequency of angina events, intensity of suffering, and the Canadian Cardiovascular Society (CCS) grading of angina pectoris were evaluated at baseline and one month after. Additionally, the Seattle Angina Questionnaire (SAQ) was assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Baseline characteristics were comparable between the two groups. At 1-month follow-up, patients administered with alprostadil experienced fewer angina episodes [episodes per week, 1 (2) vs. 2 (2), <jats:italic>P<\/jats:italic> &amp;lt; 0.001] and less pain intensity [self-evaluated pain score, 2 (3) vs. 3 (4), <jats:italic>P<\/jats:italic> &amp;lt; 0.001] than those with isosorbide dinitrate. In the alprostadil group, 78.4% of patients were classified as CCS class I, significantly higher than the 47.1% seen in the isosorbide dinitrate group (<jats:italic>P<\/jats:italic> = 0.001). Furthermore, treatment of alprostadil led to a significant improvement in the SAQ score (7.09 U, 95% CI: 4.22\u20139.96, <jats:italic>P<\/jats:italic> &amp;lt; 0.001) compared to isosorbide dinitrate. Additionally, fewer patients suffered headaches when receiving alprostadil (7.8% vs. 19.6%, <jats:italic>P<\/jats:italic> = 0.084).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Alprostadil was more effective in ameliorating angina symptoms in CSFP patients than isosorbide dinitrate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical trial registration<\/jats:title><jats:p>[<jats:ext-link>www.chictr.org.cn<\/jats:ext-link>], identifier [ChiCTR2000033233].<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2022.965364","type":"journal-article","created":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T06:31:29Z","timestamp":1662618689000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Alprostadil vs. isosorbide dinitrate in ameliorating angina episodes in patients with coronary slow flow phenomenon: A randomized controlled trial"],"prefix":"10.3389","volume":"9","author":[{"given":"Weifeng","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinjie","family":"Dai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lan","family":"Shen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaowen","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ke","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoxiao","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaolei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ziyong","family":"Hao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisheng","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xingbiao","family":"Qiu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linghong","family":"Shen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ben","family":"He","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,9,8]]},"reference":[{"key":"B1","first-page":"37","article-title":"The coronary slow flow phenomenon: characteristics, mechanisms and implications.","volume":"1","author":"Wang","year":"2011","journal-title":"Cardiovasc Diagn Ther"},{"key":"B2","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1016\/j.ijcard.2011.09.014","article-title":"Potential mechanisms of the acute coronary syndrome presentation in patients with the coronary slow flow phenomenon - insight from a plasma proteomic approach.","volume":"156","author":"Kopetz","year":"2012","journal-title":"Int J Cardiol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/383181","article-title":"Diverse spectrum of presentation of coronary slow flow phenomenon: a concise review of the literature.","volume":"2012","author":"Chaudhry","year":"2012","journal-title":"Cardiol Res Pract"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-019-01291-5","article-title":"Value of exercise stress electrocardiography for stratification of exercise capacity and left ventricular systolic and diastolic function on coronary slow flow: case-control study.","volume":"19","author":"Wang","year":"2019","journal-title":"BMC Cardiovasc Disord"},{"key":"B5","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1136\/heartjnl-2019-315909","article-title":"Coronary slow flow is associated with a worse clinical outcome in patients with Takotsubo syndrome.","volume":"106","author":"Montone","year":"2020","journal-title":"Heart"},{"key":"B6","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/j.atherosclerosis.2013.10.033","article-title":"Inverse correlation between coronary and retinal blood flows in patients with normal coronary arteries and slow coronary blood flow.","volume":"232","author":"Arbel","year":"2014","journal-title":"Atherosclerosis"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2771b","DOI":"10.1093\/eurheartj\/ehs246","article-title":"Coronary microvascular dysfunction in the clinical setting: from mystery to reality.","volume":"33","author":"Herrmann","year":"2012","journal-title":"Eur Heart J."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.1093\/eurheartj\/eht513","article-title":"Coronary microvascular dysfunction: an update.","volume":"35","author":"Crea","year":"2014","journal-title":"Eur Heart J"},{"key":"B9","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1016\/j.ijcard.2018.04.119","article-title":"Intracoronary infusion of alprostadil and nitroglycerin with targeted perfusion microcatheter in STEMI patients with coronary slow flow phenomenon.","volume":"265","author":"Sheng","year":"2018","journal-title":"Int J Cardiol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1161\/01.cir.76.1.142","article-title":"Thrombolysis in Myocardial Infarction (TIMI) Trial, Phase I: a comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge.","volume":"76","author":"Chesebro","year":"1987","journal-title":"Circulation"},{"key":"B11","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1093\/ehjci\/jew082","article-title":"Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the american society of echocardiography and the european association of cardiovascular imaging.","volume":"17","author":"Nagueh","year":"2016","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"B12","first-page":"371","article-title":"The Canadian Cardiovascular Society grading of angina pectoris revisited 30 years later.","volume":"18","author":"Campeau","year":"2002","journal-title":"Can J Cardiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1016\/0735-1097(94)00397-9","article-title":"Development and evaluation of the Seattle Angina Questionnaire: a new functional status measure for coronary artery disease.","volume":"25","author":"Spertus","year":"1995","journal-title":"J Am Coll Cardiol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"2841","DOI":"10.1016\/j.jacc.2018.09.006","article-title":"Stratified medical therapy using invasive coronary function testing in angina: the CorMicA trial.","volume":"72","author":"Ford","year":"2018","journal-title":"J Am Coll Cardiol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1408","DOI":"10.1056\/NEJMoa1916370","article-title":"Health-status outcomes with invasive or conservative care in coronary disease.","volume":"382","author":"Spertus","year":"2020","journal-title":"N Engl J Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1159\/000063121","article-title":"The coronary slow flow phenomenon\u2013a new coronary microvascular disorder.","volume":"97","author":"Beltrame","year":"2002","journal-title":"Cardiology"},{"key":"B17","first-page":"462","article-title":"Clinical manifestations of slow coronary flow from acute coronary syndrome to serious arrhythmias.","volume":"16","author":"Wozakowska-Kaplon","year":"2009","journal-title":"Cardiol J"},{"key":"B18","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1016\/S0002-8703(03)00124-8","article-title":"Coronary hemodynamic and metabolic studies of the coronary slow flow phenomenon.","volume":"146","author":"Beltrame","year":"2003","journal-title":"Am Heart J"},{"key":"B19","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1161\/01.cir.74.5.964","article-title":"Histologic evidence for small-vessel coronary artery disease in patients with angina pectoris and patent large coronary arteries.","volume":"74","author":"Mosseri","year":"1986","journal-title":"Circulation"},{"key":"B20","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1590\/S0066-782X2011005000105","article-title":"Vascular endothelial function in patients with coronary slow flow and the effects of nebivolol.","volume":"97","author":"Gunes","year":"2011","journal-title":"Arq Bras Cardiol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"106","DOI":"10.5603\/CJ.a2017.0132","article-title":"Effects of hyperbaric oxygen on vascular endothelial function in patients with slow coronary flow.","volume":"25","author":"Li","year":"2018","journal-title":"Cardiol J"},{"key":"B22","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.arcmed.2013.10.019","article-title":"Increased plasma high-sensitivity C-reactive protein and myeloperoxidase levels may predict ischemia during myocardial perfusion imaging in slow coronary flow.","volume":"45","author":"Yurtdas","year":"2014","journal-title":"Arch Med Res"},{"key":"B23","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1097\/MCA.0000000000000773","article-title":"Assessment of the relationship between C-reactive protein-to-albumin ratio and slow coronary flow in patients with stable angina pectoris.","volume":"30","author":"Yesin","year":"2019","journal-title":"Coron Artery Dis"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00380-006-0925-1","article-title":"Early sign of atherosclerosis in slow coronary flow and relationship with angiotensin-converting enzyme I\/D polymorphism.","volume":"22","author":"Tanriverdi","year":"2007","journal-title":"Heart Vessels"},{"key":"B25","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1016\/j.atherosclerosis.2007.12.028","article-title":"Carotid artery intima-media thickness correlates with intravascular ultrasound parameters in patients with slow coronary flow.","volume":"200","author":"Camsari","year":"2008","journal-title":"Atherosclerosis"},{"key":"B26","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.ejrad.2009.07.002","article-title":"Arterial bending angle and wall morphology correlate with slow coronary flow: determination with multidetector CT coronary angiography.","volume":"77","author":"Kantarci","year":"2011","journal-title":"Eur J Radiol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1161\/CIRCULATIONAHA.112.096438","article-title":"Prediction of progression of coronary artery disease and clinical outcomes using vascular profiling of endothelial shear stress and arterial plaque characteristics: the PREDICTION Study.","volume":"126","author":"Stone","year":"2012","journal-title":"Circulation"},{"key":"B28","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.jacc.2004.03.055","article-title":"The angiographic and clinical benefits of mibefradil in the coronary slow flow phenomenon.","volume":"44","author":"Beltrame","year":"2004","journal-title":"J Am Coll Cardiol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1016\/s0002-9149(00)01503-4","article-title":"Usefulness of oral dipyridamole therapy for angiographic slow coronary artery flow.","volume":"87","author":"Kurtoglu","year":"2001","journal-title":"Am J Cardiol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1177\/1074248415571457","article-title":"Nicorandil versus nitroglycerin for symptomatic relief of angina in patients with slow coronary flow phenomenon: a randomized clinical trial.","volume":"20","author":"Sani","year":"2015","journal-title":"J Cardiovasc Pharmacol Ther"},{"key":"B31","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1097\/MCA.0000000000000294","article-title":"Effects of liposomal prostaglandin E1 on periprocedural myocardial injury in patients with unstable angina undergoing an elective percutaneous coronary intervention.","volume":"26","author":"Fan","year":"2015","journal-title":"Coron Artery Dis"},{"key":"B32","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1016\/j.jcmg.2014.12.008","article-title":"Coronary microvascular dysfunction, microvascular angina, and treatment strategies.","volume":"8","author":"Marinescu","year":"2015","journal-title":"JACC Cardiovasc Imaging"},{"key":"B33","doi-asserted-by":"publisher","first-page":"109","DOI":"10.2165\/00003495-200767010-00010","article-title":"Limaprost.","volume":"67","author":"Swainston Harrison","year":"2007","journal-title":"Drugs."},{"key":"B34","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1080\/09537104.2020.1754378","article-title":"The influence of prostaglandin e1 and use of inhibitor percentage on the correlation between the multiplate and verifynow in patients on dual antiplatelet therapy.","volume":"32","author":"Hulshof","year":"2021","journal-title":"Platelets"},{"key":"B35","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1038\/sj.ijir.3900846","article-title":"Interactions between drugs for erectile dysfunction and drugs for cardiovascular disease.","volume":"14","author":"Simonsen","year":"2002","journal-title":"Int J Impot Res"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1056\/NEJM199701023360101","article-title":"Treatment of men with erectile dysfunction with transurethral alprostadil. Medicated Urethral System for Erection (MUSE) study group.","volume":"336","author":"Padma-Nathan","year":"1997","journal-title":"N Engl J Med"},{"key":"B37","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1111\/j.1743-6109.2008.01118.x","article-title":"Long-term, multicenter study of the safety and efficacy of topical alprostadil cream in male patients with erectile dysfunction.","volume":"6","author":"Rooney","year":"2009","journal-title":"J Sex Med"},{"key":"B38","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1016\/j.jsxm.2016.01.016","article-title":"Pharmacotherapy for erectile dysfunction: recommendations from the fourth international consultation for sexual medicine (ICSM 2015).","volume":"13","author":"Hatzimouratidis","year":"2016","journal-title":"J Sex Med"},{"key":"B39","doi-asserted-by":"publisher","first-page":"2949","DOI":"10.1093\/eurheartj\/eht296","article-title":"2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology.","volume":"34","author":"Task Force","year":"2013","journal-title":"Eur Heart J"},{"key":"B40","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1002\/clc.20140","article-title":"Effects of atorvastatin on coronary flow reserve in patients with slow coronary flow.","volume":"30","author":"Caliskan","year":"2007","journal-title":"Clin Cardiol"},{"key":"B41","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1159\/000109405","article-title":"Simvastatin may improve myocardial perfusion abnormality in slow coronary flow.","volume":"110","author":"Cakmak","year":"2008","journal-title":"Cardiology"},{"key":"B42","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1007\/s12471-016-0883-x","article-title":"Effect of statins on coronary blood flow after percutaneous coronary intervention in patients with stable coronary artery disease.","volume":"25","author":"Cerit","year":"2017","journal-title":"Neth Heart J"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2022.965364\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T06:31:35Z","timestamp":1662618695000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2022.965364\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,8]]},"references-count":42,"alternative-id":["10.3389\/fcvm.2022.965364"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2022.965364","relation":{},"ISSN":["2297-055X"],"issn-type":[{"type":"electronic","value":"2297-055X"}],"subject":[],"published":{"date-parts":[[2022,9,8]]},"article-number":"965364"}}