Author + information
- Received July 6, 1983
- Revision received October 19, 1983
- Accepted October 21, 1983
- Published online April 1, 1984.
- Lloyd W. Klein, MD*,
- John Ambrose, MD, FACC,
- Augusto Pichard, MD, FACC,
- James Holt, MA,
- Richard Goblin, MD, FACC and
- Louis E. Teichholz, MD, FACC
The acute changes in coronary blood flow and coronary resistance that occur in response to cigarette smoking have not been accurately determined. To define the factors that affect this response, coronary sinus blood flow was measured in 16 patients (group 1) with coronary artery disease and in 6 patients (group II) without angiographically detectable coronary disease. Seven patients (group IA) had severe (≥75%) proximal left coronary lesions and nine patients (group IB) had significant distal lesions with 50% or less proximal stenoses. Group I had a smaller overall increase ( ↑ 1.6 ± 5.3%) in coronary sinus blood flow than did group II ( ↑ 7.7 ± 6.1 %) (p < 0.05). Coronary resistance increased overall ( ↑ 2.7 ± 5.3%) in group I but decreased (↓ 2.4 ± 3.4%) in group II (p < 0.05). Patients in group IA had a highly significant increase in coronary resistance as compared with group IB ( ↑ 7.0 ± 4.2% versus ↓ 0.9 ± 2.6%) (p < 0.001). Coronary sinus flow tended to decrease (↓ 1.2 ± 4.6%) in group IA but to increase (↑ 3.8 ± 5.1%) in group IB (p = 0.06).
It is concluded that smoking increases coronary resistance in patients with coronary artery disease. A greater impact is observed in patients with a severe proximal stenosis than in those with a distal stenosis. It is proposed that smoking increases coronary artery tone at the site of the stenosis, limiting the coronary flow response proportionally to the size of the affected vascular bed.
- Received July 6, 1983.
- Revision received October 19, 1983.
- Accepted October 21, 1983.
- American College of Cardiology Foundation