Key result
Provoked coronary spasm in the left circumflex artery during acetylcholine testing occurred in 12.6% of patients, significantly less frequent than in other coronary vessels (P<0.001).
Why the study?
Does acetylcholine testing provoke spasm differently in the left circumflex artery compared to other coronary arteries?
Cohort (n=1,392)
Does acetylcholine testing provoke spasm differently in the left circumflex artery compared to other coronary arteries?
p-value: p=<0.001
Acetylcholine testing provokes spasm significantly less frequently in the left circumflex artery compared to the LAD and RCA, and when it does occur, it is usually part of multi-vessel spasm.
Lower LCx spasm rates during acetylcholine testing; supports regional vasoreactivity differences but leaves open protocol refinements.
BACKGROUND: We encounter a less provoked spasm in the left circumflex artery (LCX) by acetylcholine (ACh) testing compared with left anterior descending artery and right coronary artery (RCA) in the real world. OBJECTIVES: We investigated the clinical characteristics of provoked spasm in the LCX by ACh testing. METHODS: We retrospectively analyzed consecutive 1392 ACh testing over 20 years (1991-2011). The maximal ACh dose was 100 μg into the left coronary artery and 80 μg into the RCA. Positive spasm was defined as transient of more than or equal to 90% narrowing and usual chest symptoms or ischemic ECG changes. RESULTS: Positive provoked spasm was recognized in 622 patients (44.7%) including 456 RCA spasms, 448 left anterior descending artery spasms, and 176 LCX spasms. LCX-provoked spasm was significantly lower than other vessels (P<0.001). LCX-provoked spasm was observed in 176 patients, of whom 113 patients (64.2%) had triple-vessel spasm, 46 patients (26.1%) had double-vessel spasm, and 17 patients (9.7%) had single-vessel spasm. More than 90% patients with LCX-provoked spasm had multiple spasms. Of 17 patients with LCX single-vessel spasm, 15 patients (88.2%) had focal spasm. CONCLUSION: Under a maximal ACh dose of 100 μg into the left coronary artery, LCX-provoked spasm was significantly lower than other vessels and more than 90% of patients had multiple spasms.
No takes yet. Share an insight, caveat, or question.
Sueda et al. (2016) conducted a cohort in Suspected coronary artery spasm (n=1,392). Acetylcholine testing in the left circumflex artery vs. Acetylcholine testing in the left anterior descending and right coronary arteries was evaluated on Positive provoked spasm (≥90% narrowing with chest symptoms or ischemic ECG changes) (p=<0.001). Provoked coronary spasm in the left circumflex artery during acetylcholine testing occurred in 12.6% of patients, significantly less frequent than in other coronary vessels (P<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: