Differences in Clinical and Angiographic Parameters Following Intracoronary Ergnovine and Acetylcholine Provocation Test in Young Patients

초록

Background Ergonovine (Erg) and acetylcholine (Ach) are useful agents for assessing significant coronary artery spasm (CAS). However, there are few data concerning the coronary response between Erg and Ach. The aim of this study was to compare simultaneous Erg and Ach provocation testing in young patients (≤65 years of age). Methods A total 5,896 young patients who underwent Erg or Ach provocation testing between November 2004 and June 2021 were enrolled. Significant CAS was defined as focal or diffuse severe transient luminal narrowing (>70%) with or without chest pain or ST-T-segment change on electrocardiography. We divided into 2 groups according to provocation agents: the Erg group (n = 429) and the Ach group (n = 5,467). We investigated whether there are differences in clinical and angiographic characteristics according to provocation agents. Results Baseline clinical characteristics were similar between the 2 groups except that that Erg group had more elderly patients (52.28 ± 10.37 vs 51.19 ± 9.66; P = 0.036) but had a lower prevalence of hypertension (35.4% vs 41.2%; P = 0.019) and fewer smokers (19.6% vs 24.8%; P = 0.016). The Ach group had a higher rate of myocardial bridge, electrocardiographic changes, chest pain, atrioventricular node block, and positive CAS results. However, lower rates of baseline spastic change were shown in the Ach group. The Erg group received a higher rate of a high concentration dose compared with the Ach provocation test. Conclusions Ach was more sensitive even to lower Ach dose compared with Erg in young patients. Further study would be of major importance to validate the different parameters and different positive rates between the 2 agents.