Anti-Anginal Efficacy of Zibotentan in the Coronary Slow-Flow Phenomenon

Sivabaskari Pasupathy, Rosanna Tavella, Christopher Zeitz, Suzanne Edwards, Matthew Worthley, Margaret Arstall, John F. Beltrame

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Background: Patients with coronary microvascular disorders often experience recurrent angina for which there are limited evidence-based therapies. These patients have been found to exhibit increased plasma levels of endothelin; thus, selective endothelin–A (Et-A) receptor blockers such as zibotentan may be an effective anti-anginal therapy in these patients. The study evaluated the impact of a 10 mg daily dose of zibotentan on spontaneous angina episodes in patients with the coronary slow-flow phenomenon who had refractory angina (i.e., experiencing angina at least three times/week despite current anti-anginal therapy). Methods: Using a randomized, double-blind, placebo-controlled, crossover trial design with 4-week treatment periods, 18 patients (63.2 ± 9.9 years, 33% females) were recruited. The primary endpoint was angina frequency as measured by an angina diary, with secondary endpoints including nitrate consumption, angina duration/severity and the Seattle Angina Questionnaire (SAQ) domains. Results: During the 4 weeks of therapy, angina frequency significantly improved with zibotentan therapy (placebo 41.4 (58.5) vs. zibotentan 29.2 (31.6), p < 0.05), and sublingual nitrate consumption significantly reduced (placebo 11.8 (15.2) vs. zibotentan 8.8 (12.9), p < 0.05. Conclusions: Zibotentan improved the frequency of spontaneous angina episodes and reduced sublingual nitrate consumption in patients unresponsive to standard anti-anginal therapy.

Original languageEnglish
Article number1337
Number of pages9
JournalJournal of Clinical Medicine
Issue number5
Early online date27 Feb 2024
Publication statusPublished - 1 Mar 2024
Externally publishedYes


  • coronary microvascular dysfunction
  • coronary slow-flow phenomenon
  • zibotentan


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