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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

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Impact of preceding acetylcholine provocation testing on following coronary physiological assessment during an

Tatsuro Yamazaki1, Yuichi Saito1, Daichi Yamashita1

  • 1Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.

Journal of Cardiology
|June 28, 2023
PubMed

Insights

The order of diagnostic tests for ischemia with no obstructive coronary arteries (INOCA) matters. Preceding acetylcholine (ACh) provocation can alter subsequent coronary physiological assessment results, especially if the ACh test is positive.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Diagnostic Procedures

Background:

  • Ischemia with no obstructive coronary arteries (INOCA) requires accurate diagnosis.
  • Intracoronary acetylcholine (ACh) provocation and coronary physiological assessment are key diagnostic tools for INOCA.
  • The optimal sequence of these diagnostic procedures remains debated.

Purpose of the Study:

  • To investigate the impact of performing the intracoronary acetylcholine (ACh) provocation test before coronary physiological assessment.
  • To compare coronary physiological indices based on the sequence and outcome of the ACh test in patients with suspected INOCA.

Main Methods:

  • 120 patients with suspected INOCA underwent invasive coronary physiological assessment.
  • Patients were divided into groups based on whether ACh provocation preceded the assessment (ACh group) or not (no ACh group).
  • The ACh group was further stratified into positive and negative ACh test results.

Main Results:

  • Fractional flow reserve was lower in the no ACh group compared to the ACh group.
  • Resting mean transit time was significantly longer in the positive ACh group (1.22 ± 0.55s), followed by the no ACh (1.00 ± 0.46s) and negative ACh (0.74 ± 0.36s) groups (p < 0.001).
  • Index of microcirculatory resistance and coronary flow reserve showed no significant differences across groups.

Conclusions:

  • The sequence of diagnostic procedures impacts coronary physiological assessment findings in INOCA evaluation.
  • A positive acetylcholine provocation test significantly influences subsequent physiological measurements.
  • Further research is needed to establish the definitive order for INOCA diagnostic procedures.
Abstract

Keywords:
Acetylcholine provocation testCoronary physiological assessmentVasospastic angina

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