Abstract
The triptans, serotonin 5-HT 1B/1D receptor agonists exemplified by sumatriptan, are a mainstay migraine therapy but have class labeling contraindicating their use in patients with coronary artery disease. Triptans constrict human coronary artery in vitro, and there are case reports of myocardial infarction in patients using sumatriptan. However, preclinical studies with sumatriptan in normal dogs have failed to demonstrate effects on resting coronary flow. Calcitonin gene-related peptide (CGRP) receptor antagonism, exemplified by the prototype CGRP receptor antagonist peptide CGRP 8–37, is a new antimigraine mechanism which also has been reported to have no effect on coronary flow in normal, non-stressed animals. The goal of the present studies was to compare the effects of sumatriptan (10 μg/kg/min i.v.) and CGRP 8–37 (30 μg/kg/min i.v.) on systemic and coronary hemodynamics in conscious dogs under resting conditions and during myocardial reactive hyperemia following a brief 15 s of coronary artery occlusion. Neither CGRP 8–37 nor sumatriptan affected resting coronary flow. However, whereas CGRP 8–37 had no effect on myocardial reactive hyperemic response, sumatriptan reduced peak reactive hyperemic coronary artery blood flow (baseline vs treatment: 75.4 ± 12.7 vs 60.0 ± 10.3 ml/min, P < 0.05), reactive hyperemic flow (16.7 ± 5.2 vs 11.6 ± 3.3 ml, P < 0.05) and the repayment of coronary blood flow debt following coronary artery occlusion (484 ± 76 vs 369 ± 57%, P < 0.05), indicating an impairment in coronary blood flow reserve. The positive control nitric oxide synthase inhibitor L-NNA (30 mg/kg/30 min i.v.) likewise significantly attenuated myocardial reactive hyperemic response. These findings provide evidence for a differentiation between CGRP receptor antagonism and triptan effects on coronary vascular function.
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