Intracoronary injection of acetylcholine and ergonovine showed no significant difference in the overall incidence of provoked coronary artery spasm (33% vs 32%, NS).
Does intracoronary acetylcholine compare to ergonovine in the efficacy of inducing coronary artery spasm in patients with <50% stenosis?
Intracoronary acetylcholine and ergonovine are equally effective for provoking coronary artery spasm, though they may induce different spasm morphologies (diffuse vs focal).
Absolute Event Rate: 33% vs 32%
p-value: p=NS
BACKGROUND AND OBJECTIVES: There have been few studies comparing the clinical usefulness for the induction of coronary artery spasm (CAS) between acetylcholine (ACh) and ergonovine (ER). This study is designed: (1) to examine the duration of effect after intracoronary injection of ACh on the responsible vessels using a 0.014 inch, 15 MHz Doppler guide wire, and (2) to evaluate the efficacy of two pharmacological agents, ACh and ER, for the induction of CAS in patients with or =99% luminal narrowing. RESULTS: The time-averaged peak velocity returned to baseline after intracoronary injection of ACh within 10 minutes in all 120 procedures, consisted of 19 with positive spasm (RCA (n=10): 245+/-33 s; LCA (n=9): 351+/-187 s) and 101 with negative spasm (RCA (n=48): 155+/-62 s, LCA (n=53): 248+/-106 s). In the overall results, there was no difference concerning the incidence of provoked spasm between the two pharmacological agents (ACh: 33% versus ER: 32%, NS). Coronary spasms were induced by either pharmacological agent in 134 vessels. Concordance in this study was 94% in all vessels, whereas the remaining 6% of vessels were different from each other. The non-concordance rate of the right coronary artery was significantly higher than that of the left coronary artery (10% versus 4%, p<0.01). However, ER provoked more focal spasms, whereas ACh provoked more diffuse and distal spasms, compared with each other. Seventy-four (55%) of the 134 vessels had coronary spasms in the same coronary arteries. Concordance of both provoked spasm sites and spasm configurations in the same coronary artery was observed in only 18 (13%) vessels. No serious or irreversible complications were observed during the two sequential tests. CONCLUSIONS: As a spasm provocation test, there were no differences between ACh and ER. We recommend the supplementary use of these two pharmacological agents for the induction of CAS in the cardiac laboratory, if available.
Sueda et al. (Wed,) conducted a other in Suspected coronary artery spasm with <50% stenosis (n=171). Intracoronary acetylcholine vs. Intracoronary ergonovine was evaluated on Incidence of provoked coronary artery spasm (≥99% luminal narrowing) (p=NS). Intracoronary injection of acetylcholine and ergonovine showed no significant difference in the overall incidence of provoked coronary artery spasm (33% vs 32%, NS).