A negative intravenous ergonovine provocation test can yield false negatives, suggesting that patients with a clinical history of variant angina may still require treatment with calcium channel blockers or nitrates.
Negative ergonovine test may not exclude future vasospasm; this case leaves open its long-term predictive value in variant angina.
Ergonovine provocation test is known to be very sensitive for diagnosing variant angina. The patient described in this study initially presented with atypical chest pain and underwent coronary angiography and ergonovine provocation tests, which were negative. The patient was subsequently prescribed a proton pump inhibitor and prokinetics for pain relief, but then presented with acute myocardial infarction and cardiogenic shock due to coronary artery vasospasm 5 years later. This case suggests that ergonovine provocation test generates false negative results, which can lead to unwanted outcomes. Even with a negative ergonovine provocation test, prescription of calcium channel blockers or nitrates should be considered in patients with a clinical history suggestive of variant angina.
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Kim et al. (2013) studied this question.
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