Clinical implications of provocation tests for coronary artery spasm: safety, arrhythmic complications, and prognostic impact: multicentre registry study of the Japanese Coronary Spasm Association.
OBJECTIVE
Provocation tests of coronary artery spasm are useful for the diagnosis of vasospastic angina (VSA). However, these tests are thought to have a potential risk of arrhythmic complications, including ventricular tachycardia (VT), ventricular fibrillation (VF), and brady-arrhythmias. We aimed to elucidate the safety and the clinical implications of the spasm provocation tests in the nationwide multicentre registry study by the Japanese Coronary Spasm Association.


RESULTS
A total of 1244 VSA patients (M/F, 938/306; median 66 years) who underwent the spasm provocation tests were enrolled from 47 institutes. The primary endpoint was defined as major adverse cardiac events (MACEs). The provocation tests were performed with either acetylcholine (ACh, 57%) or ergonovine (40%). During the provocation tests, VT/VF and brady-arrhythmias developed at a rate of 3.2 and 2.7%, respectively. Overall incidence of arrhythmic complications was 6.8%, a comparable incidence of those during spontaneous angina attack (7.0%). Multivariable logistic regression analysis demonstrated that diffuse right coronary artery spasm (P < 0.01) and the use of ACh (P < 0.05) had a significant correlation with provocation-related VT/VF. During the median follow-up of 32 months, 69 patients (5.5%) reached the primary endpoint. The multivariable Cox proportional hazard model revealed that mixed (focal plus diffuse) type multivessel spasm had an important association with MACEs (adjusted hazard ratio, 2.84; 95% confidence interval, 1.34-6.03; P < 0.01), whereas provocation-related arrhythmias did not.


CONCLUSIONS
The spasm provocation tests have an acceptable level of safety and the evaluation of spasm type may provide useful information for the risk prediction of VSA patients.
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Aoba-ku, Sendai, Japan.
Yusuke
Y
Takagi
Satoshi
S
Yasuda
Jun
J
Takahashi
Ryusuke
R
Tsunoda
Yasuhiro
Y
Ogata
Atsushi
A
Seki
Tetsuya
T
Sumiyoshi
Motoyuki
M
Matsui
Toshikazu
T
Goto
Yasuhiko
Y
Tanabe
Shozo
S
Sueda
Toshiaki
T
Sato
Satoshi
S
Ogawa
Norifumi
N
Kubo
Shin-ichi
S
Momomura
Hisao
H
Ogawa
Hiroaki
H
Shimokawa
D000109:Acetylcholine; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D003329:Coronary Vasospasm / Q000175:diagnosis*; D004874:Ergonovine; D005260:Female; D006801:Humans; D006985:Hyperventilation / Q000503:physiopathology; D008297:Male; D061214:Patient Safety; D011446:Prospective Studies; D012042:Registries; D014661:Vasoconstriction / Q000187:drug effects; D014662:Vasoconstrictor Agents
D014662:Vasoconstrictor Agents; D000109:Acetylcholine; D004874:Ergonovine