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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

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Intracoronary acetylcholine testing among 746 consecutive Japanese patients with angina-like chest pain and

Shozo Sueda1, Tomoki Sakaue2

  • 1Department of Cardiology, Ehime Prefectural Niihama Hospital, Hongou 3 choume 1-1, Ehime Prefecture, Niihama City 792-0042, Japan.

European Heart Journal Open
|August 3, 2022
PubMed

Insights

Intracoronary acetylcholine testing detected epicardial spasm (ES) in 44% and coronary microvascular spasm (CMS) in 5% of Japanese patients with unobstructed coronary artery disease. CMS was more common in women and the left coronary artery.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Testing

Background:

  • Intracoronary acetylcholine (ACh) testing is a valuable tool for diagnosing epicardial spasm (ES) and coronary microvascular spasm (CMS).
  • Understanding the incidence and characteristics of ES and CMS in specific populations, like Japanese patients with unobstructed coronary artery disease, is crucial for accurate diagnosis and management.

Purpose of the Study:

  • To determine the incidence of epicardial spasm (ES) and coronary microvascular spasm (CMS) in Japanese patients undergoing intracoronary acetylcholine testing for suspected myocardial ischemia.
  • To analyze the clinical characteristics and demographic differences between patients with ES and CMS.

Main Methods:

  • Retrospective analysis of 1864 patients undergoing intracoronary ACh testing from 1991 to 2019.
  • Inclusion of 746 consecutive Japanese patients with unobstructed coronary arteries (<50% stenosis) and suspected myocardial ischemia.
  • Defined ES as ≥90% stenosis with symptoms and ECG changes; defined CMS as <75% stenosis with symptoms and ECG changes.

Main Results:

  • Epicardial spasm (ES) was detected in 44% (329/746) of patients, while coronary microvascular spasm (CMS) was found in 5% (40/746).
  • Women constituted 22% of ES patients and 65% of CMS patients.
  • CMS was more frequently observed in the left coronary artery (LCA) and in women.

Conclusions:

  • Coronary microvascular spasm (CMS) is less common than epicardial spasm (ES) in Japanese patients with unobstructed coronary artery disease, occurring in 5% versus 44% respectively.
  • CMS is disproportionately observed in women and affects the left coronary artery more often.
  • Intracoronary ACh testing effectively differentiates between ES and CMS, aiding in the diagnosis of ischemic heart disease.
Abstract

Keywords:
Acetylcholine testingCoronary microvascular spasmEpicardial spasmJapanese population

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