Work

Myocardial Perfusion and Angina Improvement Following Allopurinol Therapy in a Patient With Coronary Artery Fistula

Year: 2025

Type: article

Abstract: BACKGROUND: Coronary artery fistulas (CAFs) can lead to ischemia and angina in the absence of obstructive coronary artery disease. There is no evidence supporting a noninterventional approach to improve ischemia or alleviate symptoms for patients with refractory angina associated with CAFs. CASE SUMMARY: An 85-year-old woman presented with angina functional class 3 despite being on 3 antianginal medications. Myocardial scintigraphy showed reversible hypoperfusion in the left ventricle's lateral, inferolateral, and inferior walls. A coronary angiogram showed no obstructions; however, a CAF was found. Considering the patient's frailty and unsuitability for cardiac intervention, she was enrolled in a high-dose allopurinol protocol, which led to a significant improvement in symptoms, exercise capacity, and myocardial perfusion. DISCUSSION: This case highlighted allopurinol as a potential alternative for alleviating ischemia and angina in patients with CAF deemed not good candidates for cardiac interventions.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.105010