Safety and usefulness of acetylcholine provocation test in patients with no culprit lesions on emergency coronary angiography

Tateishi, Kazuya; Saito, Yuichi; Kitahara, Hideki; Shoji, Toshihiro; Kadohira, Tadayuki; Nakayama, Takashi; Fujimoto, Yoshihide; Kobayashi, Yoshio

doi:10.1016/j.ijcard.2018.06.108

Cited by 26 publications

(12 citation statements)

References 15 publications

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“…The American Heart Association and American College of Cardiology guidelines also indicated that intracoronary provocative tests may be undertaken after ACS has become stable [83,84]. However, some recent reports showed that during emergent CAG, ACh-provocation test was safely performed in ACS patients with nonobstructive culprit lesions and was useful to diagnose coronary spasminduced ACS in those patients [6,7,85]. Nonetheless, the indication for the ACh-provocation test during emergent CAG in ACS patients remains controversial.…”

Section: Diagnosis Of Coronary Spasm By the Ach-provocation Testmentioning

confidence: 99%

Role of acetylcholine spasm provocation test as a pathophysiological assessment in nonobstructive coronary artery disease

Kaikita

Yamamoto

Jinnouchi

et al. 2020

Cardiovasc Interv and Ther

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Coronary angiography (CAG) sometimes shows nonobstructive coronary arteries in patients with suspected angina or acute coronary syndrome (ACS). The high prevalence of nonobstructive coronary artery disease (CAD) in those patients has recently been reported not only in Japan but also in Western countries, and is clinically attracting attention. Coronary spasm is considered to be one of the leading causes of both suspected stable angina and ACS with nonobstructive coronary arteries. Coronary spasm could also be associated with left ventricular dysfunction leading to heart failure, which could be improved following the administration of calcium channel blockers. Because we rarely capture spontaneous attacks of coronary spasm with electrocardiograms or Holter recordings, an invasive diagnostic modality, acetylcholine (ACh) provocation test, can be useful in detecting coronary spasm during CAG. Furthermore, we can use the ACh-provocation test to identify high-risk patients with coronary spasm complicated with organic coronary stenosis, and then treat with intensive care. Nonobstructive CAD includes not only epicardial coronary spasm but also microvascular spasm or dysfunction that can be associated with recurrent anginal attacks and poor quality of life. ACh-provocation test could also be helpful for the assessment of microvascular spasm or dysfunction. We hope that cardiologists will increasingly perform ACh-provocation test to assess the pathophysiology of nonobstructive CAD.

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Section: Diagnosis Of Coronary Spasm By the Ach-provocation Testmentioning

confidence: 99%

Role of acetylcholine spasm provocation test as a pathophysiological assessment in nonobstructive coronary artery disease

Kaikita

Yamamoto

Jinnouchi

et al. 2020

Cardiovasc Interv and Ther

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“…The effective rate of CCB in VA patients in Japan was 92.5% [16] which is similar to our stenting group (88%)and stent-free group(89%) Other literatures reported that aspirin, statins and ACEi could prevent spasm and improve the prognosis of patients [17][18][19] . In addition, we included VA patients,whose diagnostic criteria included resting angina and transient elevation of ST segment one ECG without spasm provocation test, but could be diagnosed as VA with high specificity [10,20,21] , it has been reported that provocation test is safe and effective for VA patients with no significant stenosis [22] ,but provocation test has more advantages than disadvantages for VA patients with severe stenosis [23] , We believe that provocation test may lead to unstable plaque shedding, which increases the incidence of MACE and affects the results of the trial. Most of the studies mentioned in this paper are diagnosed as VSA by provocation test, but ST-segment depression is more common than elevation during coronary spasm [24] , so we don't think the two situations should be studied together.…”

Section: Discussionmentioning

confidence: 99%

Prognosis of stent implantation on variant angina with severe organic stenosis

Sang

Jiang

Wang

et al. 2019

Preprint

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Objective: To explore the prognosis of stent implantation on variant angina (VA) with severe organic stenosis. Background: Vasospasm is the pathogenesis of VA. Most VA patients are effective on calcium channel blockers (CCB) or nitrates, and the prognosis is generally good, but organic stenosis is a risk factor for VA. Method: We collected 141 VA patients treated with CCB and (or) nitrates in the First Affiliated Hospital of Zhengzhou University from December 2010 to June 2019. VA patients with diameter stenosis ≥50% were enrolled .They were divided into two groups according to the presence of stent implantation. The main adverse cardiovascular events (MACE) were observed including cardiogenic death, non-fatal myocardial infarction, readmission due to angina attack, coronary revascularization and heart failure. Results: 69 cases were included: 33 cases received stent implantation and 36 cases received medical treatment. The proportion of left anterior descending (LAD)(48% vs 44%,p=0.737 )which was the culprit coronary artery was very high. Diameter stenosis (84.3%±6.5 %VS 59.9%±010.1%，P<0.001)in stenting group was higher than that in stent-free group. Following up for 24 ± 23 months, there was no significant difference in the incidence of MACE (9% VS 11%) including cardiac death (3% VS 2.8%), coronary revascularization (0% VS 3%) and readmission due to angina (6% VS 5.6%), and effectiveness (88% VS 89%) between the two groups. CONCLUSION: Although the two groups showed similar clinical outcomes, with anti-spastic and antiplatelet medication, stent implantation was of benefit to the prognosis of VA with severe organic stenosis.

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“…A survey from Japan revealed that up to 40% of patients with angina might have a component of VSA [ 6 ]; however, the exact prevalence is unknown. Although provocative testing during invasive coronary angiography has gained traction in recent years, it is still only performed at a few specialised centres.…”

Section: Epidemiologymentioning

confidence: 99%

Coronary Vasospastic Angina: A Review of the Pathogenesis, Diagnosis, and Management

Rehan

Weaver

Yong

2022

Life

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Vasospastic angina (VSA) is an under-appreciated cause of chest pain. It is characterised by transient vasoconstriction of the coronary arteries and plays a significant role in the pathogenesis of stable angina and acute coronary syndromes. Complex mechanistic pathways characterised by endothelial dysfunction and smooth muscle hypercontractility lead to a broad spectrum of clinical manifestations ranging from recurrent angina to fatal arrhythmias. Invasive provocation testing using intracoronary acetylcholine or ergonovine is considered the current gold standard for diagnosis, but there is a wide variation in protocols amongst different institutions. Conventional pharmacological therapy relies on calcium channel blockers and nitrates; however, refractory VSA has limited options. This review evaluates the pathophysiology, diagnostic challenges, and management strategies for VSA. We believe global efforts to standardise diagnostic and therapeutic guidelines will improve the outcomes for affected patients.

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Safety and usefulness of acetylcholine provocation test in patients with no culprit lesions on emergency coronary angiography

Cited by 26 publications

References 15 publications

Role of acetylcholine spasm provocation test as a pathophysiological assessment in nonobstructive coronary artery disease

Role of acetylcholine spasm provocation test as a pathophysiological assessment in nonobstructive coronary artery disease

Prognosis of stent implantation on variant angina with severe organic stenosis

Coronary Vasospastic Angina: A Review of the Pathogenesis, Diagnosis, and Management

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