title: Moderate vasomotor response to acetylcholine provocation test as an indicator of long-term prognosis.
abstract: The acetylcholine (ACh) provocation test (ACh-test) is used for the diagnosis of vasospastic angina (VSA). However, subjects often show a moderate spasm (MS) response for which diagnosis of VSA is not definitive, and the clinical significance of this response is unknown. We assessed moderate coronary vasomotor response to the ACh test as an indicator of long-term prognosis. A total of 298 consecutive patients who underwent the ACh test for suspected VSA were retrospectively investigated. Coronary spasm severity after intracoronary administration of isosorbide dinitrate was evaluated by measuring epicardial coronary artery diameter reduction after ACh injection. Patients were divided into three groups according to the diameter reduction during the ACh test: severe spasm (SS) showing ≥75 % diameter reduction, MS showing ≥50 % diameter reduction, and others (N). In Kaplan-Meier analysis, the major adverse cardiac event (MACE) rates with a median follow-up of 4.6 years were significantly worse in SS (11.1 %) and MS (8.5 %) than N (1.9 %), (SS vs N; P = 0.009, MS vs N; P = 0.029). Significant difference in MACE rates was not observed between SS and MS (P = 0.534). Cox regression analysis revealed that MS remained an independent predictor of MACE after adjustment for other confounders (HR: 7.18, 95 % CI 1.42-36.4, P = 0.017). Patients with MS by ACh test had a cardiac event rate comparable with that of patients with SS and significantly worse than that of patients with normal vasomotor responses.
authors.affiliation: Department of Cardiology, Kameda Medical Center, 929 Higashi-cho Kamogawa City, Chiba, 296-8602, Japan. masaedamasa@gmail.com.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hoshino
authors.affiliation: Department of Cardiology, Kameda Medical Center, 929 Higashi-cho Kamogawa City, Chiba, 296-8602, Japan.
authors.forename: Taishi
authors.initials: T
authors.lastname: Yonetsu
authors.affiliation: Department of Cardiology, Kameda Medical Center, 929 Higashi-cho Kamogawa City, Chiba, 296-8602, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Mizukami
authors.affiliation: Department of Cardiology, Kameda Medical Center, 929 Higashi-cho Kamogawa City, Chiba, 296-8602, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Matsuda
authors.affiliation: Department of Cardiology, Kameda Medical Center, 929 Higashi-cho Kamogawa City, Chiba, 296-8602, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yoshioka
authors.affiliation: Department of Cardiology, Kameda Medical Center, 929 Higashi-cho Kamogawa City, Chiba, 296-8602, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Sudo
authors.affiliation: Department of Cardiology, Kameda Medical Center, 929 Higashi-cho Kamogawa City, Chiba, 296-8602, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Ninomiya
authors.affiliation: Department of Cardiology, Kameda Medical Center, 929 Higashi-cho Kamogawa City, Chiba, 296-8602, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Soeda
authors.affiliation: Department of Cardiology, Kameda Medical Center, 929 Higashi-cho Kamogawa City, Chiba, 296-8602, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Kuroda
authors.affiliation: Department of Cardiology, Kameda Medical Center, 929 Higashi-cho Kamogawa City, Chiba, 296-8602, Japan.
authors.forename: Maki
authors.initials: M
authors.lastname: Ono
authors.affiliation: Department of Cardiology, Kameda Medical Center, 929 Higashi-cho Kamogawa City, Chiba, 296-8602, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Iwatsuka
authors.affiliation: Department of Cardiology, Kameda Medical Center, 929 Higashi-cho Kamogawa City, Chiba, 296-8602, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Department of Cardiology, Kameda Medical Center, 929 Higashi-cho Kamogawa City, Chiba, 296-8602, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Matsumura
authors.affiliation: Department of Cardiology, Kameda Medical Center, 929 Higashi-cho Kamogawa City, Chiba, 296-8602, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Hashimoto
mesh_terms: D000109:Acetylcholine / Q000008:administration & dosage*; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis* / Q000503:physiopathology; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000175:diagnosis / Q000503:physiopathology; D003331:Coronary Vessels / Q000187:drug effects* / Q000503:physiopathology; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014661:Vasoconstriction / Q000187:drug effects*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*; D014666:Vasomotor System / Q000187:drug effects* / Q000503:physiopathology
chemical_list: D014662:Vasoconstrictor Agents; D000109:Acetylcholine
keywords: Acetylcholine; Endothelial dysfunction; Prognosis; Spasm