Sex-Related Differences in the Prognostic Role of Acetylcholine Provocation Testing

Area of Science:

• Cardiology
• Vascular Medicine
• Clinical Research

Background:

• Intracoronary acetylcholine (ACh) testing aids diagnosis and risk stratification in patients with ischemia with nonobstructed coronary arteries (NOCA) and myocardial infarction with NOCA.
• Potential sex-related disparities in the prognostic significance of ACh testing require exploration.

Purpose of the Study:

• To investigate sex-specific differences in the prognostic implications of acetylcholine provocation testing.
• To assess the impact of ACh testing results on major adverse cardiovascular and cerebrovascular events, angina recurrence, and quality of life in men and women.

Main Methods:

• A cohort of 519 patients with ischemia with NOCA or myocardial infarction with NOCA underwent ACh provocation testing.
• Primary endpoint: major adverse cardiovascular and cerebrovascular events. Co-primary endpoints: angina recurrence and Seattle Angina Questionnaire (SAQ) summary score at 12 months.

Main Results:

• A positive ACh test was observed in 52.8% of patients, with higher microvascular spasm prevalence in women and epicardial spasm in men.
• Men with positive ACh tests had significantly higher rates of major adverse cardiovascular and cerebrovascular events.
• Women with positive ACh tests reported increased angina recurrence and lower quality of life (SAQ score).

Conclusions:

• Sex-specific differences in the prognostic value of ACh testing are crucial for managing coronary vasomotor disorders.
• Recognizing these disparities can lead to more personalized risk stratification and treatment strategies.