New combined spasm provocation test in patients with rest angina - Intracoronary injection of acetylcholine after intracoronary administration of ergonovine
S. Sueda et al., New combined spasm provocation test in patients with rest angina - Intracoronary injection of acetylcholine after intracoronary administration of ergonovine, JPN CIRC J, 64(8), 2000, pp. 559-565
Citations number
30
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
The incidence of provoked coronary spasm with the standard single spasm pro
vocation test has been relatively low in patients with rest angina. The pre
sent study examined the clinical usefulness of a newly designed spasm provo
cation test, an intracoronary injection of acetylcholine (ACh) following an
ergonovine (ER) test, in patients with rest angina who demonstrated low di
sease activity and atypical chest pain. Triple sequential spasm provocation
tests were performed in 24 patients with atypical chest pain who had no is
chemia and in 40 patients with rest angina who had distinct ischemia. Initi
ally, an ACh test (20-100 mu g) and then an ER test (40-64 mu g) were perfo
rmed and then, if no spasm was provoked, an intracoronary injection of ACh
was given after the ER test to evaluate coronary spasm. Coronary spasm was
defined as total or subtotal occlusion. In the 24 patients with atypical ch
est pain, no spasm was provoked by intracoronary injection of either ACh or
ER, but coronary spasms were induced in 2 patients using the new method, w
ith the remaining 22 not experiencing spasm (specificity of new method, 92%
). In the 40 patients with rest angina, intracoronary injection of ACh indu
ced coronary spasm in 22 patients (group I) and 6 (group II) demonstrated s
pasm with intracoronary injection of ER. Coronary spasm was not induced by
either the ACh test or the ER test in 12 patients (group III). The intracor
onary administration of ACh after the ER test provoked spasm in 11 of 12 pa
tients. Diffuse spasms were provoked in 10 of 11 patients. In patients with
rest angina, the frequency of chest pain attacks in 1 month experienced by
patients in group III (0.8+/-0.8) was significantly lower than that of pat
ients in group I (7.0+/-5.3, p<0.01) or II (3.5+/-2.3, p<0.05). No serious
or irreversible complications related to this new combined method were obse
rved. In conclusion, this method was safe and reliable fur the induction of
coronary spasm in patients with rest angina who may have low disease activ
ity.