Routine intracoronary acetylcholine infusion caused adverse reactions in 16% of patients, with a significantly higher risk in those younger than 60 years (RR 5.6; 95% CI 2.2-14.3).
Observational (n=299)
Does routine intracoronary acetylcholine infusion cause adverse reactions in patients undergoing a first diagnostic coronary angiogram?
Routine intracoronary acetylcholine infusion for endothelial function testing carries a 16% risk of adverse reactions, with a notably higher risk in patients under 60 years of age.
Effect estimate: RR 5.6 (95% CI 2.2-14.3)
BACKGROUND: Recent findings imply prognostic significance of intracoronary acetylcholine infusion for endothelial function testing. We evaluated whether routine use of this test in coronary angiography patients is safe. METHODS: Patients undergoing a first diagnostic coronary angiography were selected to receive intracoronary acetylcholine for endothelial function evaluation. The relation between adverse reactions during infusion and risk factors was analyzed with a logistic regression model. Included in the multiple logistic regression model were the variables with a univariate P value < 0.20. RESULTS: Adverse reactions occurred in 16% (49/299) of the patients. This included two life-threatening events caused by occlusive spasm and flow limitation in the left coronary artery. Other adverse events were chest pain (n = 38), AV block or sinus bradycardia (n = 10), dyspnea (n = 3). Adverse reactions were more likely to occur in patients younger than 60 years of age (relative risk, 5.6 2.2-14.3). CONCLUSION: Intracoronary acetylcholine infusion is safe, but may lead to serious adverse reactions. Care should be taken especially in patients younger than 60 years of age. Routine use of acetylcholine infusion can thus only be justified if it has important prognostic significance. This has to be proven further in large prospective studies.
Tio et al. (Fri,) conducted a observational in Patients undergoing a first diagnostic coronary angiogram (n=299). Intracoronary acetylcholine infusion was evaluated on Adverse reactions during infusion (RR 5.6, 95% CI 2.2-14.3). Routine intracoronary acetylcholine infusion caused adverse reactions in 16% of patients, with a significantly higher risk in those younger than 60 years (RR 5.6; 95% CI 2.2-14.3).