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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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Abnormal epicardial coronary vasomotor reactivity is associated with altered outcomes

Hélène Aélion1, Fabien Picard2, Arnaud Jégou3

  • 1Cardiology Department, Cochin Hospital, AP-HP, 75014 Paris, France; Faculty of Medicine, University of Paris Cité, 75014 Paris, France.

Archives of Cardiovascular Diseases
|December 16, 2022
PubMed

Insights

Abnormal epicardial coronary vasomotor reactivity (ACVR) is common in patients with ischemic symptoms and normal coronary arteries. Provocative testing (PT) safely identifies patients at high risk for adverse cardiovascular events.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Imaging

Background:

  • Abnormal epicardial coronary vasomotor reactivity (ACVR) significance in patients with ischemic symptoms and non-obstructive coronary artery disease is unclear.
  • Current diagnostic strategies involve provocative testing (PT) for patients with chest pain and no significant coronary stenosis.

Purpose of the Study:

  • To evaluate the incidence, safety, and patient outcomes associated with using PT to diagnose ACVR.
  • Assess the risk of major adverse cardiovascular and cerebrovascular events (MACCE) in patients with and without ACVR.

Main Methods:

  • Retrospective observational study with a median 5-year clinical follow-up.
  • Analysis of patients undergoing coronary angiography and subsequent PT.
  • Primary outcome: incidence of ACVR. Secondary outcomes: MACCE (death, cardiovascular mortality, myocardial infarction, stroke, revascularization).

Main Results:

  • ACVR was identified in 12.4% of patients undergoing PT.
  • ACVR patients were more likely female, current smokers, and presented with suspected acute coronary syndrome.
  • Patients with ACVR had a significantly higher incidence of MACCE, including myocardial infarction and coronary revascularization.

Conclusions:

  • ACVR is a frequent finding in patients with ischemic symptoms and normal coronary arteries.
  • Provocative testing (PT) is a safe and effective strategy for identifying patients with ACVR.
  • Identifying ACVR highlights a population at increased risk for recurrent ischemic events.
Abstract

Keywords:
Coronary spasmProvocative testVasomotor reactivity

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