Key result
Sequential acetylcholine and ergonovine testing improves detection of coronary spasm in nonobstructive CAD.
Why the study?
Single vasoreactivity testing has clinical limitations and potential pseudonegative results in detecting coronary spasm endotypes, prompting reconsideration of supplementary or sequential testing.
Does sequential vasoreactivity testing improve the diagnosis of coronary epicardial and microvascular spasm in patients with nonobstructive coronary artery disease?
Does sequential vasoreactivity testing improve the diagnosis of coronary epicardial and microvascular spasm in patients with nonobstructive coronary artery disease?
Sequential vasoreactivity testing with acetylcholine and ergonovine helps overcome the limitations of single provocation tests for diagnosing coronary spasm.
May support sequential testing to reduce missed spasm diagnoses; leaves open need for prospective outcome trials before routine use.
Vasoreactivity testing is used by cardiologists in the diagnosis of coronary spasm endotypes, such as epicardial and microvascular spasm. Intracoronary injection of acetylcholine and ergonovine is defined as a standard class I method according to the Coronary Vasomotion Disorder (COVADIS) Group. Because single vasoreactivity testing may have some clinical limitations in detecting the presence of coronary spasm, supplementary or sequential vasoreactivity testing should be reconsidered. The majority of cardiologists do not consider pseudonegative results when performing these vasoreactivity tests. Vasoreactivity testing may have some limitations when it comes to documenting clinical spasm. In the future, cardiologists around the world should use multiple vasoreactivity tests to verify the presence or absence of epicardial and microvascular spasms in the cardiac catheterisation laboratory.
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Sueda et al. (2024) conducted a review in Nonobstructive coronary artery disease (NOCAD). Vasoreactivity testing (acetylcholine and ergonovine) was evaluated. Sequential vasoreactivity testing using acetylcholine and ergonovine improves the diagnosis of epicardial and microvascular coronary spasm in patients with nonobstructive coronary artery disease.
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