Key result
Patients with myocardial infarction and unobstructed coronaries had more epicardial spasm (35% vs 19%, p=0.017) than stable angina patients, with similar complication rates (1% vs 2.5%, p=0.438).
Why the study?
Coronary spasm can cause myocardial infarction with unobstructed coronary arteries, but it has been questioned whether intracoronary acetylcholine testing is feasible and safe in the acute phase.
Is intracoronary acetylcholine testing safe and feasible in the acute phase of myocardial infarction with unobstructed coronary arteries compared to patients with stable angina?
Cohort (n=180)
Is intracoronary acetylcholine testing safe and feasible in the acute phase of myocardial infarction with unobstructed coronary arteries compared to patients with stable angina?
Intracoronary acetylcholine testing is safe and feasible in the acute phase of myocardial infarction with unobstructed coronary arteries, with a complication rate comparable to stable angina patients.
Answers are grounded in this paper and cite their sources.
Supports early acetylcholine testing for spasm in acute MINOCA; leaves open whether routine acute provocation improves.
BACKGROUND: Coronary spasm is an established cause for myocardial infarction with unobstructed coronary arteries, and can be diagnosed using intracoronary acetylcholine testing. However, it has been questioned whether such testing is feasible and safe in the acute phase. The aim of this study was to assess the frequency of coronary spasm and the safety of the acetylcholine test in patients with myocardial infarction with unobstructed coronary arteries compared to patients with stable angina and unobstructed coronaries. METHODS: One hundred and eighty selected patients (52% women, mean age 62±13 years) with either myocardial infarction with unobstructed coronary arteries (n=80) or stable angina and unobstructed coronaries (n=100) were enrolled from 2007-2018. All patients underwent the acetylcholine test according to a standardised protocol immediately after diagnostic angiography. Apart from assessment of clinical, demographic and risk factor data, side effects and complications during the acetylcholine test were recorded. RESULTS: Overall, epicardial spasm was found in 26% with a higher prevalence among the myocardial infarction with unobstructed coronary arteries compared to the stable angina patients (35% vs 19%, p=0.017). Microvascular spasm was found in 42% with a higher prevalence among the stable patients compared to the myocardial infarction with unobstructed coronary arteries cohort (53% vs 29%, p=0.0014). There were no statistically significant differences in the rate of side effects (16% vs 14%, p=0.674) or complications (1% vs 2.5%, p=0.438) between the two groups. None of the patients experienced irreversible complications. CONCLUSION: Coronary spasm is a frequent cause for myocardial infarction with unobstructed coronary arteries. Spasm provocation testing using acetylcholine is feasible in such patients in the acute phase. The complication rate during acetylcholine testing in myocardial infarction with unobstructed coronary arteries patients is low and comparable to patients with stable angina.
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Probst et al. (2020) conducted a cohort in Myocardial infarction with unobstructed coronary arteries (n=180). Myocardial infarction with unobstructed coronary arteries vs. Stable angina and unobstructed coronaries was evaluated on Epicardial spasm (p=0.017). Patients with myocardial infarction and unobstructed coronaries had more epicardial spasm (35% vs 19%, p=0.017) than stable angina patients, with similar complication rates (1% vs 2.5%, p=0.438).
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