Frequency of provoked coronary vasospasm in patients undergoing coronary arteriography with spasm provocation test of acetylcholine

This study examines the incidence of spasm by intracoronary injection of ac etylcholine in Japanese patients who underwent coronary angiography. The su bjects were 685 consecutive patients (477 men, mean age 63.2 +/- 7.5 years) who were studied with an acetylcholine test. Acetylcholine was injected in incremental doses of 20, 50, and 80 mu g into the right coronary artery an d 20, 50, and 100 mu g into the left coronary artery. Spasm was defined as total or subtotal occlusion. Coronary vasospasm was determined in 221 patie nts (32.3%). Spasm occurred often during effort and rest in patients with a ngina (25 of 51, 49.0%), exertional angina (25 of 74, 33.8%), recent myocar dial infarction (30 of 80, 37.5%), healed myocardial infarction (14 of 37, 37.8%), and especially in patients with rest angina (83 of 124, 66.9%), whe reas spasm was relatively uncommon in patients with nonischemic heart disea se (23 of 252, 9.1%). Spasm was superimposed on significant atherosclerotic lesions in 35.9% of patients as well as on nonfixed atherosclerotic lesion s in 30.8% of patients. We conclude that >9% of Japanese patients may have coronary vasospasm with intracoronary injection of acetylcholine and recomm end the provocation test for evaluating coronary vasospasm if coronary angi ography is undertaken. (C)1999 by Excerpta Medica, Inc.