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Updated: Aug 14, 2026
Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
Published on: August 18, 2016
Smoking and hyperlipidemia are important risk factors for coronary artery spasm
Dingcheng Xiang1, Franz Xaver Kleber
1Department of Cardiology, Liuhuaqiao Hospital, Guangzhou 510010, China. dcxiang@yahoo.com.cn
Insights
Coronary artery spasm is a key cause of chest pain without significant stenosis. Smoking and hyperlipidemia are identified as major clinical risk factors for this condition.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Testing
Background:
- Chest pain with normal coronary arteries is common.
- Coronary artery spasm is a potential cause of such symptoms.
- Identifying risk factors for coronary artery spasm is clinically important.
Purpose of the Study:
- To determine the etiological role of coronary artery spasm in patients with chest pain and no significant coronary stenosis.
- To identify clinical risk factors associated with coronary artery spasm.
Main Methods:
- Intracoronary acetylcholine testing was performed on 275 patients with chest pain and no significant coronary stenosis.
- Coronary artery spasm was diagnosed based on a 90% stenosis increase with chest pain and ECG changes.
- Logistic regression analyzed risk factors including sex, age, hypertension, diabetes, smoking, and hyperlipidemia.
Main Results:
- Coronary artery spasm was detected in 38% of patients (103/271).
- Smoking (4.2x) and hyperlipidemia (2.3x) significantly increased the risk of coronary artery spasm.
- Diabetes mellitus showed a negative association with coronary artery spasm.
Conclusions:
- Coronary artery spasm is a significant etiological factor in patients presenting with chest pain but without obstructive coronary artery disease.
- Smoking and hyperlipidemia are identified as primary clinical risk factors for developing coronary artery spasm.
Objective:
To investigate the role of coronary artery spasm in the etiology of chest pain lacking significant coronary stenosis and to identify the clinical risk factors related to coronary artery spasm.
Methods:
Two hundred and seventy five patients with chest pain, but without significant coronary artery stenosis underwent the intracoronary acetylcholine test. Coronary artery spasm was diagnosed while coronary artery stenosis increased to 90% and was accompanied by the usual chest pain with or without ischemic changes on electrocardiogram. Logistic regression was employed to investigate the relationships between coronary artery spasm and sex, age, hypertension, diabetes mellitus, smoking, hyperlipidemia and results of electrocardiographic treadmill stress test. Left ventricular ejection fraction and end diastolic pressure were compared between spasm group and non-spasm group.
Results:
Coronary artery spasm was detected in 103 out of 271 patients, a rate of 38%. Logistic regression analysis showed that smoking and hyperlipidemia increased the relative risk of coronary artery spasm 4.2 times and 2.3 times, respectively. There was a significantly negative relationship between diabetes mellitus and coronary artery spasm. Furthermore, there was no significant difference of left ventricular ejection fraction and end diastolic pressure between spasm group and non-spasm group.
Conclusions:
Coronary artery spasm was one of the important etiological factors for patients with chest pain but no coronary artery stenosis. Smoking and hyperlipidemia were the main clinical risk factors for coronary artery spasm.
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