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

초록

Background Ergnovine (Erg) or Acetylcholine (Ach) is a useful agent to evaluate significant coronary artery spasm (CAS). Dyslipidemia is a risk factor of significant coronary artery disease (CAD). However, there are limited reports comparing Ach and Erg to coronary spasm provocation test in dyslipidemia patients. Methods A total of 1,614 dyslipidemia patients who underwent Erg or Ach provocation test were classified into two groups; Erg provocation test group (n=203) and Ach provocation test group (n=1,384). We investigated whether there are differences in clinical and angiographic characteristics according to intracoronary Erg or Ach provocation test in dyslipidemia patients. Results Baseline clinical characteristics were similar between the two groups except that Erg group were more elderly but had a lower prevalence of hypertension and peripheral vascular disease (Table 1). During the Ach provocation test, the frequency of myocardial bridge and incidence of ECG changes, ischemic chest pain, and atrioventricular node block were the higher. More patients responded to lower Ach dose but higher Erg dose during the provocation test in patients with dyslipidemia. In CAS positive patients with dyslipidemia, more patients who were provoked by Ach showed a response in the left anterior descending artery, mid and distal site. Whereas CAS were induced at a higher frequency at the proximal site during Erg provocation test in patients with dyslipidemia (Table 2). Conclusions As a spasm provocation test, Ach was more sensitive even to lower Ach dose as compared to Erg in patients with dyslipidemia. Baseline clinical characteristics and angiographic parameters were different between Erg and Ach provocation tests. It is suggested that two agents can be selected depending on whether the patient has dyslipidemia or not for diagnosed CAS in the future.