Differences in Clinical and Angiographic Parameters of Intracoronary Ergonovine and Acetylcholine to Coronary Spasm Provocation Test in Smokers

초록

Background When cardiologists diagnose patients with coronary artery spasm (CAS), Ergnovine (Erg) or Acetylcholine (Ach) is a useful agent to evaluate significant CAS. According to previous reports, smoking is known to be a risk factor for coronary artery disease and CAS. However, there are limited reports comparing Ach and Erg to coronary spasm provocation test in current smokers. Methods A total of 1695 smoking patients who underwent Erg or Ach provocation test between Nov. 2004 and June 2021 were enrolled. Significant CAS was defined as > 70% of narrowing by incremental intracoronary Erg injection of 20, 40 and 80 μg or Ach injection of 20, 50 and 100 μg. They were classified into two groups: Erg provocation test group (n=102) and Ach provocation test group (n=1,575). We investigated whether there are differences in clinical and angiographic characteristics according to intracoronary Erg or Ach provocation test in smokers. Results Baseline clinical characteristics were similar between the two groups except that Erg group had a higher prevalence of dyslipidemia and was a lower heart rate compared to Ach group (Table 1). During the Ach provocation test, the frequency of myocardial bridge and incidence of atrioventricular node block were the higher. More patients responded to lower Ach dose and higher Erg dose during the provocation test in smokers. In CAS positive patients with smoking, more patients who were provoked by Ach showed a response in the left anterior descending artery site (Table 2). Conclusions As a spasm provocation test, Ach was more sensitive even to lower Ach dose as compared to Erg in current smokers. Baseline clinical characteristics and angiographic parameters were different between Erg and Ach provocation tests. We suggest that two agents could be selected by smoking to diagnose CAS in the future.