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Updated: Jun 15, 2025

Testing Acetylcholine Followed by Adenosine for Invasive Diagnosis of Coronary Vasomotor Disorders
Published on: February 3, 2021
Lack of Class I Vasoreactivity Testing for Diagnosing Patients With Coronary Artery Spasm
Shozo Sueda1, Yutaka Hayashi1, Hiroki Ono2
1Department of Cardiology, Minami Matsuyama Hospital, Matsuyma City, Ehime, Japan.
Background:
Vasoreactivity testing, such as intracoronary acetylcholine (ACh) or ergometrine (EM), is defined as Class I for the diagnosis of patients with vasospastic angina (VSA) according to recommendations from the Coronary Vasomotion Disorders International Study (COVADIS) group and guidelines from the Japanese Circulation Society (JCS).
Hypothesis:
Although vasoreactivity testing is a clinically useful tool, it carries some risks and limitations in diagnosing coronary artery spasm.
Methods:
Previous reports on vasoreactivity testing for diagnosing the presence of coronary spasm are summarized from the perspective of Class I.
Results:
There are several problems such as reproducibility, underestimation, overestimation, and inconclusive/nonspecific results associated with daily spasm. Because provoked spasm caused by intracoronary ACh is not always similar to that caused by intracoronary EM, possibly due to different mediators, supplementary use of these vasoreactivity tests is necessary for cardiologists to diagnose VSA when a provoked spasm is not revealed by each vasoactive agent.
Conclusions:
Cardiologists should understand the imperfection of these vasoreactivity tests when diagnosing patients with VSA.
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