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Updated: Oct 1, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Safety evaluation of routine intracoronary acetylcholine infusion in patients undergoing a first diagnostic coronary
R A Tio1, S H J Monnink, G Amoroso
1Department of Cardiology, Thoraxcenter, University Hospital Groningen, The Netherlands. r.a.tio@thorax.azg.nl
Insights
Intracoronary acetylcholine infusion is generally safe for endothelial function testing in coronary angiography patients. However, serious adverse reactions can occur, particularly in those under 60.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Endothelial function testing via intracoronary acetylcholine infusion shows prognostic significance.
- Safety of routine acetylcholine infusion during coronary angiography requires evaluation.
Purpose of the Study:
- To assess the safety of routine intracoronary acetylcholine infusion in patients undergoing coronary angiography.
Main Methods:
- A logistic regression model analyzed the relationship between adverse reactions and risk factors.
- Patients undergoing first-time diagnostic coronary angiography received intracoronary acetylcholine.
Main Results:
- 16% of patients experienced adverse reactions, including two life-threatening events (occlusive spasm, left coronary artery flow limitation).
- Common adverse events included chest pain, bradycardia, and dyspnea.
- Younger patients (<60 years) had a higher likelihood of adverse reactions (RR 5.6).
Conclusions:
- Intracoronary acetylcholine infusion is safe but carries risks of serious adverse reactions, especially in younger patients.
- Caution is advised for patients under 60 undergoing this procedure.
- Further large prospective studies are needed to confirm prognostic significance before routine use.
Background:
Recent findings imply prognostic significance of intracoronary acetylcholine infusion for endothelial function testing. We evaluated whether routine use of this test in coronary angiography patients is safe.
Methods:
Patients undergoing a first diagnostic coronary angiography were selected to receive intracoronary acetylcholine for endothelial function evaluation. The relation between adverse reactions during infusion and risk factors was analyzed with a logistic regression model. Included in the multiple logistic regression model were the variables with a univariate P value < 0.20.
Results:
Adverse reactions occurred in 16% (49/299) of the patients. This included two life-threatening events caused by occlusive spasm and flow limitation in the left coronary artery. Other adverse events were chest pain (n = 38), AV block or sinus bradycardia (n = 10), dyspnea (n = 3). Adverse reactions were more likely to occur in patients younger than 60 years of age (relative risk, 5.6 [2.2-14.3]).
Conclusion:
Intracoronary acetylcholine infusion is safe, but may lead to serious adverse reactions. Care should be taken especially in patients younger than 60 years of age. Routine use of acetylcholine infusion can thus only be justified if it has important prognostic significance. This has to be proven further in large prospective studies.
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