Related Experiment Video

Updated: Jul 12, 2025

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

15.8K

Which Coronary Artery Should Be Preferred for Starting the Coronary Spasm Provocation Test?

Hiroki Teragawa1, Yuko Uchimura1, Chikage Oshita1

  • 1Department of Cardiovascular Medicine, JR Hiroshima Hospital, 3-1-36, Futabanosato, Higashi-ku, Hiroshima 732-0057, Japan.

Life (Basel, Switzerland)
|October 28, 2023
PubMed

Insights

Initiating the spasm provocation test (SPT) in the left coronary artery (LCA) may lead to a higher incidence of multivessel spasm (MVS), particularly in the left circumflex artery. However, diagnostic rates for vasospastic angina (VSA) and complication frequencies remain similar regardless of the starting vessel.

Area of Science:

  • Cardiology
  • Diagnostic Testing
  • Interventional Cardiology

Background:

  • The spasm provocation test (SPT) is crucial for diagnosing vasospastic angina (VSA).
  • The optimal artery (right coronary artery or left coronary artery) for initiating SPT remains undetermined.
  • This study evaluates SPT outcomes and complications based on the initial vessel choice.

Purpose of the Study:

  • To compare the diagnostic yield and complication rates of SPT when initiated in the right coronary artery (RCA) versus the left coronary artery (LCA).
  • To investigate the influence of the initial SPT vessel on the occurrence of multivessel spasm (MVS).

Main Methods:

  • A cohort of 225 patients undergoing coronary angiography and SPT was analyzed.
  • Patients were divided into two groups: SPT initiated in the RCA (n=133) or LCA (n=92).
  • Propensity score matching (PSM) was applied to 120 patients for balanced group comparison.

Main Results:

  • No significant differences in VSA diagnosis or SPT-related complications were found between RCA and LCA groups initially.
  • Spasms occurred most frequently in the left anterior descending artery in both groups.
  • The LCA group showed a higher frequency of left circumflex artery spasms and MVS, even after PSM.

Conclusions:

  • While VSA diagnostic rates and complication frequencies are comparable, initiating SPT in the LCA increases the likelihood of MVS due to higher rates of left circumflex artery spasm.
  • Starting routine SPT from the LCA is suggested based on these findings.
Abstract

Keywords:
coronary spasmmultivessel spasmspasm provocation testvasospastic angina

More Related Videos

Measurement of Myocardial Lactate Production for Diagnosis of Coronary Microvascular Spasm06:18

Measurement of Myocardial Lactate Production for Diagnosis of Coronary Microvascular Spasm

Published on: September 17, 2021

1.4K
Testing Acetylcholine Followed by Adenosine for Invasive Diagnosis of Coronary Vasomotor Disorders05:58

Testing Acetylcholine Followed by Adenosine for Invasive Diagnosis of Coronary Vasomotor Disorders

Published on: February 3, 2021

3.5K

Related Concept Videos

Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
9
Acute Coronary Syndrome I: Introduction01:30

Acute Coronary Syndrome I: Introduction

Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
30
Angina III: Clinical Manifestations and Assessment01:29

Angina III: Clinical Manifestations and Assessment

Angina manifests as chest pain, tightness, or squeezing discomfort typically located behind the breastbone. It can radiate to the neck, jaw, shoulders, and inner aspects of the upper arms, most commonly the left arm. Patients may experience shortness of breath, fatigue, profuse sweating, dizziness, indigestion, heartburn, palpitations, anxiety, and vomiting as accompanying symptoms. This pain often lasts a few minutes and is triggered by physical exertion, emotional stress, heavy meals, or cold...
9
Angina I: Introduction01:30

Angina I: Introduction

Definition and Symptoms: Angina (angina pectoris) is chest pain or discomfort caused by myocardial ischemia, which occurs when the heart muscle receives insufficient oxygen-rich blood. It typically manifests as pressing, squeezing, or crushing sensations in the chest and may radiate to the shoulders, arms, neck, jaw, or back.Primary Cause: In a healthy state, the coronary arteries can dilate (widen) to increase blood flow and meet the increased oxygen demand during physical activity or...
12
Coronary Circulation01:21

Coronary Circulation

The heart, an organ critical to survival, gets nourishment not from the blood it pumps but from a separate circulation system known as coronary circulation. This is the shortest circulation in the body and is responsible for supplying the heart with the nutrients it needs to function effectively.
Coronary circulation begins at the base of the aorta, where two main arteries arise—the left and right coronary arteries. These arteries encircle the heart in the coronary sulcus and supply the...
2.8K
Coronary Artery Disease V: Interprofessional Care01:27

Coronary Artery Disease V: Interprofessional Care

Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
9