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Updated: Jul 23, 2026

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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Predicting the response to acetylcholine in ischemia or infarction with non-obstructive coronary arteries: The ABCD

Riccardo Rinaldi1, Michele Colucci1, Ilaria Torre1

  • 1Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy.

Atherosclerosis
|March 6, 2024
PubMed

Insights

A new ABCD score predicts positive acetylcholine tests in patients with non-obstructed coronary arteries. This score can help avoid invasive testing, reducing risks and costs for patients with INOCA or MINOCA.

Area of Science:

  • Cardiology
  • Diagnostic testing
  • Vascular medicine

Background:

  • Acetylcholine (ACh) provocation testing identifies vasomotor disorders in Ischemia and Non-Obstructed Coronary Arteries (INOCA) and Myocardial Infarction and Non-Obstructed Coronary Arteries (MINOCA) patients.
  • Predicting a positive ACh test response is crucial for timely diagnosis and treatment.

Purpose of the Study:

  • To derive and validate a simple risk score, the ABCD score, for predicting a positive ACh test response in INOCA and MINOCA patients.

Main Methods:

  • Prospective enrollment of 551 INOCA and MINOCA patients undergoing ACh testing.
  • Patients were divided into derivation (n=386) and validation (n=165) cohorts.
  • The ABCD score was developed based on predictors: Myocardial Infarction and Non-Obstructed Coronary Arteries (MINOCA), myocardial bridge (MB), C-reactive protein (CRP), and dyslipidemia.

Main Results:

  • The ACh test was positive in 52.3% of patients.
  • Independent predictors for a positive ACh test included MINOCA, MB, elevated CRP, and dyslipidemia.
  • The ABCD score demonstrated good predictive accuracy (AUC 0.703 in derivation, 0.705 in validation).
  • An ABCD score ≥4 indicated a 94.3% risk of a positive ACh test; scores ≥6 were always positive.

Conclusions:

  • The ABCD score can potentially obviate the need for ACh provocation testing in high-risk patients, thereby reducing procedural risks, time, and costs.
  • Implementation of the ABCD score may facilitate tailored treatment strategies for INOCA and MINOCA.
  • Further multicenter trials are recommended to validate and refine the ABCD score.
Abstract

Keywords:
AcetylcholineCoronary vasospasmDiagnosisINOCAMINOCA

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