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Prognosis of patients with previous myocardial infarction, coronary slow flow, and normal coronary angiogram

  • A. ZivanicEmail author
  • I. Stankovic
  • I. Ilic
  • B. Putnikovic
  • A. N. Neskovic
Original articles



There is a common assumption that patients with coronary slow flow (CSF) have an excellent prognosis in the absence of coronary artery stenoses. Little is known about whether a history of previous coronary events affects the long-term survival in this population. In this retrospective, observational study, we assessed the possible association of a previous coronary event and long-term prognosis in patients with CSF but without significant coronary artery stenoses.


A total of 141 patients (70 male; median age: 59 years, range: 33–78 years) with CSF and normal coronary angiograms were included in the study. Patients were followed up for all-cause mortality during a period of 47 ± 22 months.


Previous myocardial infarction (MI) was reported by 16 (11%) patients who had similar left ventricular ejection fraction (LVEF) as those without previous MI (51 ± 16 vs. 53 ± 16%, p = 0.595). Patients with previous MI more often had an abnormal resting electrocardiogram (69 vs. 40%, p = 0.03), while there were no significant differences in other baseline clinical characteristics (p > 0.05 for age, gender, risk factors, pharmacological treatment). In univariate Cox analysis, only previous MI was associated with unfavorable long-term survival (log-rank p = 0.012), while an abnormal electrocardiogram, LVEF, and other clinical variables were not (log-rank p > 0.05, for all). Kaplan–Meier analysis revealed unfavorable long-term survival in patients with CSF and a history of previous MI.


In patients with CSF and an otherwise normal coronary angiogram, a history of a previous MI is associated with unfavorable long-term outcomes.


Coronary stenosis Heart attack Angiography Risk factors Prognosis 

Prognose von Patienten mit früherem Myokardinfarkt, langsamem Koronarfluss und normalem Koronarangiogramm



Es besteht die allgemeine Annahme, dass Patienten mit langsamem Koronarfluss („coronary slow flow“, CSF) eine ausgezeichnete Prognose haben, wenn keine Koronarstenose vorliegt. Nur wenig ist darüber bekannt, ob koronare Ereignisse in der Anamnese sich auf das Langzeitüberleben in dieser Population auswirken. In dieser retrospektiven Beobachtungsstudie wurde ein möglicher Zusammenhang zwischen einem früheren koronaren Ereignis und der Langzeitprognose bei Patienten mit CSF, aber ohne relevante Koronarstenosen untersucht.


In die Studie wurden 141 Patienten (70 m., Durchschnittsalter: 59 Jahre, Spanne: 33–78 Jahre) mit CSF und normalem Koronarangiogramm einbezogen. Die Patienten wurden hinsichtlich der Gesamtmortalität über 47 ± 22 Monate nachbeobachtet.


Ein früherer Myokardinfarkt (MI) wurde von 16 (11 %) Patienten angegeben, die eine ähnliche linksventrikuläre Ejektionsfraktion (LVEF) wie Personen ohne vorherigen MI aufwiesen (51 ± 16 vs. 53 ± 16 %; p = 0,595). Bei Patienten mit früherem MI bestanden häufiger Auffälligkeiten im Ruhe-EKG (69 vs. 40 %; p = 0,03), jedoch gab es keine signifikanten Unterschiede bei anderen klinischen Charakteristika in der Ausgangssituation (p > 0,05 für Alter, Geschlecht, Risikofaktoren, pharmakologische Therapie). In der univariaten Cox-Analyse war nur ein früherer MI mit einem ungünstigen Langzeitüberleben verknüpft (Log-Rank-Test, p = 0,012), nicht aber ein auffälliges EKG, die LVEF und andere klinische Variablen (Log-Rank-Test, p > 0,05 für alle). Die Kaplan-Meier-Analyse ergab ein ungünstiges Langzeitüberleben bei Patienten mit CSF und einem MI in der Anamnese.


Bei Patienten mit CSF und einem ansonsten normalen Koronarangiogramm steht ein MI in der Anamnese mit ungünstigen Langzeitergebnissen in Zusammenhang.


Koronarstenose Herzanfall Angiographie Risikofaktoren Prognose 



The authors would like to thank Stefan Stankovic for his assistance with data collection.

Compliance with ethical guidelines

Conflict of interest

A. Zivanic, I. Stankovic, I. Ilic, B. Putnikovic, and A.N. Neskovic declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.


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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • A. Zivanic
    • 1
    Email author
  • I. Stankovic
    • 1
  • I. Ilic
    • 1
  • B. Putnikovic
    • 1
  • A. N. Neskovic
    • 1
  1. 1.Department of Cardiology, Clinical Hospital Center Zemun, Faculty of MedicineUniversity of BelgradeBelgradeSerbia

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