Letter to the editor
ST/T wave changes during acute coronary syndrome presentation in patients with the coronary slow flow phenomenon

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Acknowledgement

The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [17].

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    Interestingly, we found no differences in the extent of coronary stenosis or the severity of myocardial injury between MINOCA patients with CSF and those with normal coronary flow, suggesting that CSF is per se independently associated with a higher risk of MACE in MINOCA patients rather than a marker of illness severity. The association between the presence of CSF and worse clinical outcomes for MINOCA patients may, therefore, partly be due to the etiopathogenesis of CSF, which includes microvascular dysfunction contributing to myocardial ischemia and acute coronary syndrome [27,36,37,42]. Altogether, the present study's findings may have a significant clinical implication since a deeper understanding of the underlying mechanisms may allow the clinician to risk-stratify the MINOCA patients, identify appropriate therapy, and improve the survival rate of this patient group.

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    The coronary slow flow phenomenon (CSFP) is an angiographic finding characterized by delayed opacification of the distal vasculature in the absence of obstructive epicardial coronary artery disease (CAD).1

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