title: Serious cardiac complications in coronary spasm provocation tests using acetylcholine or ergonovine: analysis of 21 512 patients from the diagnosis procedure combination database in Japan.
abstract: BACKGROUND
  Previous studies on complications with coronary spasm provocation tests were based on small sample sizes or were limited to high-volume centers. The risk of provocation tests using acetylcholine (ACH) or ergonovine (ER) remains to be fully examined by a large-scale multicenter study.
  
  
  OBJECTIVE
  ACH provocation tests are associated with a higher rate of serious cardiac complications than ER tests.
  
  
  METHODS
  Using the Diagnosis Procedure Combination database in Japan, we identified patients aged ≥20 years who underwent a pharmacological provocation test during coronary angiography. We assessed the composite outcome of cardiac complications requiring urgent procedures (defibrillation, chest compression, intra-aortic balloon pumping, or extracorporeal membrane oxygenation) or death on the day of the provocation test, and compared the outcome between ACH and ER tests.
  
  
  RESULTS
  Of 21 512 eligible patients in 602 hospitals, 10 628 (49.4%) underwent an ACH test and 10 884 (50.6%) underwent an ER test. The composite outcome occurred in 141 (0.7%) patients. The ACH group was significantly more likely to have the composite outcome than the ER group (0.9% vs 0.4%, P < 0.001). The propensity-score analyses showed consistent results (propensity score-matched, 0.9% vs 0.4%, P = 0.003; inverse probability-weighted, 0.8% vs 0.4%, P < 0.001). In a multivariable logistic regression analysis, ACH tests were significantly associated with a higher rate of the composite outcome than ER tests (odds ratio: 1.75, 95% confidence interval: 1.13-2.69, P = 0.011).
  
  
  CONCLUSIONS
  This retrospective cohort study suggested that ACH tests were associated with a higher rate of cardiac complications than ER tests.
authors.affiliation: Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Isogai
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsui
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Ueda
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
mesh_terms: D000109:Acetylcholine / Q000009:adverse effects*; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000139:chemically induced* / Q000401:mortality / Q000628:therapy; D016208:Databases, Factual; D004554:Electric Countershock; D004874:Ergonovine / Q000009:adverse effects*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006334:Heart Function Tests / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000009:adverse effects*
chemical_list: D014662:Vasoconstrictor Agents; D000109:Acetylcholine; D004874:Ergonovine