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Updated: Jan 31, 2026

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

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Current Practice and Safety of Invasive Coronary Function Testing: A Nationwide Multicenter Survey in Japan

Takeshi Nishi1, Michikazu Nakai2, Masanobu Ishii3

  • 1Department of Cardiovascular Medicine, Chiba University Graduate School Medicine, Chiba, Japan; Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan.

JACC. Advances
|January 29, 2026
PubMed

Insights

Coronary function testing (CFT) is safe and feasible for diagnosing coronary vasomotor dysfunction, even in emergencies. This study supports wider use of CFT for ischemia or myocardial infarction with nonobstructive coronary arteries (INOCA/MINOCA).

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Diagnostic Testing

Background:

  • Coronary vasomotor dysfunction, including vasospastic angina and coronary microvascular dysfunction, is a primary cause of INOCA/MINOCA.
  • Invasive coronary function testing (CFT) offers diagnostic value but its real-world application and safety, particularly in emergency situations, require further evaluation.

Purpose of the Study:

  • To evaluate the current practices, diagnostic yield, and safety of CFT in Japan.
  • To assess acetylcholine (ACh) and ergonovine (ERG) provocation tests, and coronary microvascular assessments (CFR/IMR).

Main Methods:

  • A nationwide cross-sectional survey of 235 institutions in Japan.
  • Data collection on procedure volume, positivity rates, and complications for CFT performed between January 2022 and December 2023.

Main Results:

  • Over 6,900 provocation tests (ACh and ERG) and 2,100 CFR/IMR assessments were analyzed.
  • Positivity rates were 50.9% for ACh and 32.5% for ERG; major complications were rare (1.4% for ACh, 0.4% for ERG).
  • Abnormal microvascular findings were more frequent in emergency cases, with low complication rates (0.05%).

Conclusions:

  • Invasive CFT is feasible and safe, including in emergency settings for diagnosing INOCA/MINOCA.
  • The findings support the expanded use of CFT in clinical practice for patients with suspected coronary vasomotor dysfunction.
Abstract

Keywords:
coronary flow reservecoronary microvascular dysfunctioncoronary spasmthe index microcirculatory resistancevasospastic angina

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