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Updated: Apr 14, 2026

Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders
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Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders

Published on: August 18, 2016

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Clinical and Physiological Predictors of Acetylcholine-Induced Coronary Spasm in ANOCA/INOCA Patients: A

Jeremie Buri1, Aurelia Zimmerli1, Thabo Mahendiran1

  • 1Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|April 13, 2026
PubMed

Insights

Patients with non-obstructive coronary arteries (ANOCA/INOCA) experiencing angina may have coronary spasm. Age 60+ and dyslipidemia predict lower spasm odds, potentially reducing unnecessary acetylcholine testing.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Diagnostic Testing

Background:

  • A significant number of patients with angina/ischemia have non-obstructive coronary arteries (ANOCA/INOCA).
  • Coronary microvascular dysfunction and vasospasm can explain symptoms in ANOCA/INOCA patients.
  • Selecting patients for acetylcholine testing is challenging due to logistics, cost, and risk.

Purpose of the Study:

  • To identify predictors of coronary spasm in ANOCA/INOCA patients.
  • To define clinical features that may help avoid unnecessary acetylcholine testing.

Main Methods:

  • Retrospective analysis of consecutive ANOCA/INOCA patients undergoing intracoronary acetylcholine testing.
  • Multivariable logistic regression to analyze baseline clinical variables.
  • Development of a 3-variable exploratory model to predict unnecessary testing.

Main Results:

  • 46.8% of patients demonstrated a positive spasm response.
  • Age ≥ 60 years and dyslipidemia were independently associated with lower odds of spasm (p<0.05).
  • A 3-variable model showed good discrimination (AUC 0.83) and could reduce testing by 45.2%.

Conclusions:

  • Dyslipidemia and age ≥ 60 years are linked to reduced odds of acetylcholine-induced coronary spasm.
  • The developed model shows potential for reducing unnecessary acetylcholine testing in ANOCA/INOCA patients.
  • External validation is needed for these findings.
Abstract

Keywords:
ANOCAINOCAacetylcholinecoronary microvascular dysfunctioncoronary vasospasm

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