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Updated: May 26, 2025
Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
Published on: August 18, 2016
Sex-Related Differences in the Prognostic Role of Acetylcholine Provocation Testing
Riccardo Rinaldi1,2, Michele Russo3, Giovanni Occhipinti4,5
1Department of Cardiovascular and Pulmonary Sciences Catholic University of the Sacred Heart Rome Italy.
Insights
Acetylcholine (ACh) testing reveals sex-specific prognostic differences in coronary vasomotor disorders. Men with positive ACh tests face higher adverse events, while women experience more angina recurrence and lower quality of life.
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.
Background:
Intracoronary provocation testing with acetylcholine (ACh) is helpful to diagnose and risk-stratify patients with ischemia with nonobstructed coronary arteries (NOCA) and myocardial infarction with NOCA. This study explored potential sex-related disparities on the prognostic significance of ACh provocative testing.
Methods:
Consecutive patients with ischemia with NOCA and those with myocardial infarction with NOCA who underwent ACh provocation testing were enrolled. The primary end point was the incidence of major adverse cardiovascular and cerebrovascular events at follow-up. Co-primary end points were angina recurrence and quality of life assessed by 12-month Seattle Angina Questionnaire (SAQ) summary score.
Results:
A total of 519 patients (mean age, 61.4±12.1 years; 275 [53.0%] women and 244 [47%] men) were enrolled: 346 (66.7%) with ischemia with NOCA and 173 (33.3%) with myocardial infarction with NOCA. A positive ACh test was observed in 274 (52.8%) patients, with a lower prevalence of epicardial spasm (82 [56.2%] versus 106 [82.8%]) and a higher prevalence of microvascular spasm (64 [43.8%] versus 22 [17.2%]) in women compared with men (P>0.001). After a median 22-month follow-up, major adverse cardiovascular and cerebrovascular events occurred in 53 (10.2%) patients, without significant sex differences (P>0.05). Men with a positive ACh test had a significantly higher rate of major adverse cardiovascular and cerebrovascular events (22 [17.2%] versus 5 [4.3%], P=0.002) compared with those with a negative test; no difference was observed in women (P>0.05) (P for interaction=0.003). Women with a positive test experienced a higher rate of angina recurrence (61 [41.8%] versus 32 [24.8%], P=0.005) and a lower SAQ summary score (82 [interquartile range, 72-90] versus 86 [interquartile range, 78-100], P<0.001) compared with those with a negative result; no difference was observed in men (P>0.05).
Conclusions:
This study revealed the importance of recognizing sex-specific differences in the prognostic value of ACh testing for proper management of coronary vasomotor disorders.
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