DIFFERENCES IN CLINICAL AND ANGIOGRAPHIC PARAMETERS FOLLOWING INTRACORONARY ERGNOVINE AND ACETYLCHOLINE PROVOCATION TEST FOR CORONARY ARTERY SPASM

• Seung-Woon Rha, 
• Amro Elnagar, 
• Byoung Geol Choi, 
• sung il Im, 
• Sunwon Kim, 
• Jin Oh Na, 
• Seongwoo Han,
• Cheol Ung Choi, 
• Hong Euy Lim, 
• Jin Won Kim, 
• Eung Ju Kim, 
• Hong-Seog Seo, 
• Chang Gyu Park, 
• Dong Joo Oh

• Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea

Background

Ergnovine (Erg) and Acetylcholine (Ach) is an useful agent for assessing significant coronary artery spasm (CAS). However, a comparison studies of the two agents are limited.

Methods

A total 113 consecutive patients (pts) without significant coronary artery disease (CAD) who underwent Erg and/or Ach provocation test between May 2010 and October 2011 were enrolled. Significant CAS was defined as focal or diffuse severe transient luminal narrowing (>70%) with/without chest pain or ST-T change on ECG. We investigated whether there are differences in clinical and angiographic characteristics according to intracoronary Erg or Ach provocation test.

Results

Baseline clinical characteristics were similar between the two groups except the Erg group had more male gender (69.3 vs. 31.6%, < 0.001) and smokers (34.6 vs. 11.6%, <0.001). During the provocation test, the incidence of ischemic chest pain and ECG change were not different but AV block during the test was higher with Ach provocation test. More pts responded to lower Ach dose and higher Erg dose to induce significant CAS. Despite of similar incidence of multi-vessel involvement, the incidence of diffuse spasm was higher with Erg test (Table).

Conclusion

Both Erg and Ach were safe but Ach was more sensitive even to lower Ach dose as compared to Erg. Erg test was more associated with diffuse spasm whereas Ach was more associated with focal spasm.

Copyright © 2012 Published by Elsevier Inc. All rights reserved.