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Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
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Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders

Published on: August 18, 2016

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Role of acetylcholine spasm provocation test as a pathophysiological assessment in nonobstructive coronary artery

Satoru Suzuki1, Koichi Kaikita2, Eiichiro Yamamoto1

  • 1Department of Cardiovascular Medicine and Center for Metabolic Regulation of Healthy Aging, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.

Cardiovascular Intervention and Therapeutics
|October 27, 2020
PubMed

Insights

Coronary artery spasm is a key cause of nonobstructive coronary artery disease (CAD) and angina. The acetylcholine (ACh) provocation test aids in diagnosing coronary spasm, guiding treatment for patients with suspected CAD.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Vascular Medicine

Background:

  • Nonobstructive coronary artery disease (CAD) is increasingly recognized in patients presenting with angina or acute coronary syndrome (ACS).
  • Coronary artery spasm is a significant contributor to both stable angina and ACS in the absence of obstructive epicardial coronary stenosis.
  • Coronary spasm can lead to left ventricular dysfunction and heart failure, potentially responsive to calcium channel blockers.

Purpose of the Study:

  • To highlight the diagnostic utility of the acetylcholine (ACh) provocation test in identifying coronary artery spasm.
  • To emphasize the role of the ACh provocation test in managing patients with nonobstructive CAD.
  • To explore the ACh provocation test's applicability in assessing microvascular spasm and dysfunction.

Main Methods:

  • Invasive coronary angiography (CAG) with acetylcholine (ACh) provocation testing.
  • Assessment of coronary artery spasm during CAG.
  • Evaluation of microvascular function and spasm.

Main Results:

  • The ACh provocation test is effective in detecting coronary artery spasm, a common cause of nonobstructive CAD.
  • The test can identify high-risk patients with coronary spasm and concomitant organic coronary stenosis.
  • ACh provocation testing may also aid in assessing microvascular spasm or dysfunction.

Conclusions:

  • The acetylcholine (ACh) provocation test is a valuable tool for diagnosing coronary artery spasm in patients with nonobstructive coronary artery disease (CAD).
  • This invasive diagnostic modality can guide treatment strategies, including the use of calcium channel blockers, and identify high-risk individuals.
  • Increased utilization of the ACh provocation test by cardiologists is recommended for a comprehensive assessment of nonobstructive CAD pathophysiology.

Keywords:
Acetylcholine provocation testCoronary spasmMicrovascular spasmNonobstructive coronary artery disease

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