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Updated: Jul 5, 2026
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Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
Published on: August 18, 2016
Multifocal spasm with acetylcholine in Prinzmetal angina
1Department of Cardiology Catharina Hospital, Eindhoven, the Netherlands.
Summary
Prinzmetal angina can cause vasospasm in normal coronary arteries, not just blocked ones. This case highlights the importance of provocative testing to guide treatment and avoid unnecessary interventions for coronary artery disease.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Prinzmetal angina, a condition characterized by coronary artery vasospasm, can present atypically.
- Distinguishing vasospasm from fixed obstructive lesions is crucial for appropriate patient management.
- Percutaneous coronary intervention (PCI) is typically considered for significant coronary obstructions.
Purpose of the Study:
- To investigate the diagnostic utility of acetylcholine provocative testing in a patient with suspected Prinzmetal angina and a non-critical coronary obstruction.
- To determine the appropriate management strategy for coronary artery vasospasm identified during diagnostic angiography.
Main Methods:
- Coronary angiography was performed in a 60-year-old female patient with Prinzmetal angina.
- Provocative testing using incremental doses of acetylcholine was administered to assess coronary artery reactivity.
- The response of coronary segments, including the site of a non-critical obstruction, was evaluated.
Main Results:
- Acetylcholine infusion induced diffuse mild vasoconstriction and multifocal hyperreactive vasoconstriction in apparently normal coronary segments.
- No significant hyperreactivity was observed at the site of the non-critical (<50%) right coronary artery obstruction.
- These findings indicated vasospasm in non-obstructed segments, characteristic of Prinzmetal angina.
Conclusions:
- Percutaneous coronary intervention was deemed inappropriate given the absence of significant obstructive disease and the presence of vasospasm in normal segments.
- Management focused on medical therapy, including nitrates and calcium antagonists, and avoidance of beta-blockade.
- Acetylcholine provocative testing is valuable in diagnosing Prinzmetal angina and guiding therapeutic decisions, preventing unnecessary interventions.
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