title: Safety and optimal protocol of provocation test for diagnosis of multivessel coronary spasm.
abstract: We examined the safety of acetylcholine (ACh) and ergonovine (ER) tests retrospectively and investigated the optimal protocol of provocation test for diagnosis of multivessel coronary spasm. We performed 1546 ACh tests and 1114 ER tests during 23 years. ACh was injected in incremental doses of 20/50/80 μg into the right coronary artery (RCA) and of 20/50/100/200 μg into the left coronary artery (LCA) over 20 s. ER was administered in total doses of 40 μg into the RCA and of 64 μg into the LCA over 2-4 min. When a coronary spasm was induced and did not resolve spontaneously within 3 min after the completion of ACh/ER injection, or when hemodynamic instability due to coronary spasms occurred, 2.5-5.0 mg of nitrate was administered into the responsible vessel. To relive provoked spasm, it is necessary to administer nitrate in 31 cases by ACh and in 76 cases by ER (2.0 vs. 6.8 %, p < 0.01) before another vessel attempts. Multivessel spasms were often observed in LCA testing than in RCA testing on both agents [ACh: 78.6 % (11/14) vs. 11.8 % (2/17), p < 0.001, ER: 37.8 % (14/37) vs. 20.5 % (8/39), ns]. Even after the administration of nitrates, positive coronary spasm was obtained in 21.1 % by ACh and 52.9 % by ER tests on another coronary artery. No irreversible complications were recognized on both tests. We should firstly perform spasm provocation tests in the LCA and we may be able to diagnose another vessel spasm by performing the complete spasm provocation tests after the administration of nitrates to relieve provoked spasm in the first attempt.
authors.affiliation: Department of Cardiology, Ehime Niihama Prefectural Hospital, Hongou 3 choume 1-1, Niihama, Ehime, 792-0042, Japan. EZF03146@nifty.com.
authors.forename: Shozo
authors.initials: S
authors.lastname: Sueda
authors.affiliation: Department of Cardiology, Ehime Niihama Prefectural Hospital, Hongou 3 choume 1-1, Niihama, Ehime, 792-0042, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Miyoshi
authors.affiliation: Department of Cardiology, Ehime Niihama Prefectural Hospital, Hongou 3 choume 1-1, Niihama, Ehime, 792-0042, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Sasaki
authors.affiliation: Department of Cardiology, Ehime Niihama Prefectural Hospital, Hongou 3 choume 1-1, Niihama, Ehime, 792-0042, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Sakaue
authors.affiliation: Department of Cardiology, Ehime Niihama Prefectural Hospital, Hongou 3 choume 1-1, Niihama, Ehime, 792-0042, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Habara
authors.affiliation: Department of Cardiology, Ehime Niihama Prefectural Hospital, Hongou 3 choume 1-1, Niihama, Ehime, 792-0042, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kohno
mesh_terms: D000109:Acetylcholine / Q000008:administration & dosage* / Q000009:adverse effects; D000368:Aged; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000175:diagnosis* / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D004874:Ergonovine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000503:physiopathology; D061214:Patient Safety; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014661:Vasoconstriction / Q000187:drug effects; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000009:adverse effects; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D000109:Acetylcholine; D004874:Ergonovine
keywords: Acetylcholine; Ergonovine; Nitrate; Spasm relief