Why the study?
Safety concerns preclude widespread incorporation of intracoronary acetylcholine testing into clinical practice despite its role as the gold standard tool for coronary vasomotor disorders.
Invasive provocative testing with intracoronary acetylcholine is a safe and effective gold standard tool for diagnosing coronary vasomotor disorders, enabling personalized therapy for patients with INOCA and MINOCA.
May inform vasomotor disorder evaluation; extends observational data but leaves randomized outcome trials open.
Coronary vasomotor disorders (CVD) are characterized by transient hypercontraction of coronary vascular smooth muscle cells, leading to hypercontraction of epicardial and/or microvascular coronary circulation. CVDs play a relevant role in the pathogenesis of ischemia, angina and myocardial infarction with non-obstructive coronary arteries. Invasive provocative testing with intracoronary Acetylcholine (ACh) administration is the gold standard tool for addressing CVD, providing relevant therapeutic and prognostic implications. However, safety concerns preclude the widespread incorporation of the ACh test into clinical practice. The purpose of this review is to shed light on the pathophysiology underlying CVD and on the clinical role of the ACh test, focusing on safety profile and prognostic implications. We will also discuss contemporary evidence on the management of CVD and the role of the ACh test in driving a personalized approach of patients with CVD.
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Gurgoglione et al. (2024) studied this question.
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