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Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
06:39

Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders

Published on: August 18, 2016

Multivessel versus single vessel spasm, as assessed by the intracoronary acetylcholine provocation test, in Korean

Ji Young Park1, Seung-Woon Rha, Zhe Jin

  • 1Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.

Clinical and Experimental Pharmacology & Physiology
|September 22, 2011
PubMed

Insights

Multivessel coronary artery spasm (MVS) is linked to more severe ischemia than single vessel spasm (SVS). Peripheral artery disease and baseline spasm independently predict MVS, indicating a need for intensive therapy in MVS patients.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Testing

Background:

  • Coronary artery spasm (CAS) is a significant cause of myocardial ischemia.
  • Multivessel coronary spasm (MVS) typically results in more severe and prolonged myocardial ischemia compared to single vessel spasm (SVS).

Purpose of the Study:

  • To compare clinical and angiographic characteristics of patients with MVS, SVS, and no coronary artery spasm (non-CAS).
  • To identify predictors of acetylcholine (ACh)-induced MVS.

Main Methods:

  • A total of 1082 patients without significant coronary artery disease underwent acetylcholine (ACh) provocation testing.
  • Patients were categorized into MVS (n=275), SVS (n=376), and non-CAS (n=431) groups.
  • Clinical data, baseline characteristics, and ACh test responses were analyzed.

Main Results:

  • MVS patients exhibited higher prevalence of peripheral artery disease (PAD), hyperlipidaemia, smoking, older age, and higher triglycerides.
  • MVS group showed increased chest pain, ischemic ECG changes, baseline spasms, and more diffuse/severe spasms during ACh testing.
  • PAD and baseline spasm were independent predictors of ACh-induced MVS (OR 2.0 and 1.4, respectively).

Conclusions:

  • Ischemic symptoms, diffuse/severe spasm, and baseline spasm are more common in MVS patients.
  • MVS patients may require more intensive medical management and closer clinical follow-up.
  • Identifying predictors like PAD and baseline spasm aids in managing MVS patients.

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