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August 11, 2020Internal MedicineOpen Access

Bronchial Asthma and Rest Angina: Is It Safe to Perform Acetylcholine Spasm Provocation Tests in These Patients?

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Key result

Acetylcholine spasm provocation tests were performed safely with 0 complications in 13 rest angina patients with well-controlled bronchial asthma, despite the off-label use.

Why the study?

Acetylcholine use is contraindicated in patients with bronchial asthma, leaving its usefulness and safety in rest angina patients with bronchial asthma unclear.

Is it safe to perform acetylcholine spasm provocation tests in rest angina patients with well-controlled bronchial asthma?

Population

495 rest angina patients undergoing acetylcholine spasm provocation tests

Comparison

Patients with bronchial asthma vs without bronchial asthma

Design

Observational study

Authors

SSShozo Sueda

Discussion

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Member takes

Overview

ACh spasm testing may be feasible in select rest angina patients with BA; leaves open need for prospective safety confirmation before any practice change.

Study Design

Type

Observational (n=495)

Multicenter

No

Structured PICO

Is it safe to perform acetylcholine spasm provocation tests in rest angina patients with well-controlled bronchial asthma?

P
Population
495 patients with rest angina, including 13 with well-controlled bronchial asthma, who retrospectively underwent acetylcholine spasm provocation testing to evaluate safety and spasm characteristics.
E
Exposure
Acetylcholine (ACh) spasm provocation test via intracoronary injection (incremental doses of 20/50/100/200 μg into the left coronary artery and 20/50/80 μg into the right coronary artery) in patients with bronchial asthma (n=13).
C
Comparator
Rest angina patients without bronchial asthma (n=482) undergoing the same acetylcholine spasm provocation test.
O
Outcome
Safety (major complications including ventricular fibrillation, non-sustained ventricular tachycardia, or shock <60 mmHg) and clinical usefulness (provoked positive spasm defined as transient ≥90% luminal narrowing and usual chest pain or ischemic ECG changes).safety

Main Result

Absolute Event Rate: 0% vs 1.7%

Acetylcholine spasm provocation tests can be safely performed in rest angina patients with well-controlled bronchial asthma, despite current medical package insert contraindications.

Limitations

  • Retrospective, single-center study with a small sample size
  • Study population only included patients with well-controlled bronchial asthma, not medically resistant asthma
  • Retrospective, single-center study
  • Small sample size
  • Study population had well-controlled bronchial asthma (did not test medically resistant bronchial asthma)

Cite This Study

Shozo Sueda (2020) conducted an observational in Rest angina (n=495). Bronchial asthma vs. Patients without bronchial asthma was evaluated on Major complications during acetylcholine spasm provocation tests. Acetylcholine spasm provocation tests were performed safely with 0 complications in 13 rest angina patients with well-controlled bronchial asthma, despite the off-label use.

synapsesocial.com/papers/6a6dda77ce524a4339c2d620https://doi.org/10.2169/internalmedicine.5071-20
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Overview of the Acetylcholine Spasm Provocation Test2015 · 69 citations
  2. 2Clinical impact of selective spasm provocation tests: comparisons between acetylcholine and ergonovine in 1508 examinations2004 · 87 citations
  3. 3Induction of coronary artery spasm by acetylcholine in patients with variant angina: possible role of the parasympathetic nervous system in the pathogenesis of coronary artery spasm.1986 · 554 citations
  4. 4A 16-year-old boy with bronchial asthma and prinzmetal angina: case report2018 · 2 citations
  5. 5ACC/AHA Guidelines for the Management of Patients With Unstable Angina and Non–ST-Segment Elevation Myocardial Infarction: Executive Summary and Recommendations2000 · 4,505 citations