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Theodore N. Keltz, MD; Bernard Gitler, MD; Jerome A. Cooper, MD
New Rochelle, NY

JAMA. 1988;259(8):1179.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In Reply.

—We read the letter by Drs Castelló and Hidalgo with great interest. Their broader experience confirms our observation that 4% to 5% of patients awaiting coronary revascularization will develop myocardial ischemia after receiving 100 mg of dipyridamole orally.

The observed association of this clinical phenomenon with epicardial collaterals is further supported by a study by Chambers and Brown.¹ They used a stepwise multivariate logistic regression analysis to examine the relationship of angiographic findings, hemodynamic changes, thallium imaging results, and demographic variables to the development of dipyridamole-induced ischemia in 46 patients with coronary artery disease. The presence of coronary collaterals was the strongest predictor.

It seems clear that patients with collaterals are at risk for the development of dipyridamole-induced myocardial ischemia. This relationship makes a true coronary steal the likely underlying mechanism. Although aminophylline is certainly the "antidote" for side effects of dipyridamole therapy, sublingual nitroglycerin is immediately . . . [Full Text PDF of this Article]

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