Differences in Clinical and Angiographic Parameters Following Intracoronary Ergonovine and Acetylcholine Provocation Test in Elderly Patients

초록

Background Coronary artery spasm (CAS) often considered a problem of younger adults, but it can occur in elderly who also have atherosclerotic coronary artery disease. Ergonovine (Erg) and Acetylcholine (Ach) is a useful agent for assessing significant CAS. However, there are few data concerning the coronary response according to agents, respectively. Methods A total of 2,197 elderly (≥65 years of age) patients who underwent Erg or Ach provocation test between November 2004 and June 2021 were enrolled. Significant CAS was defined as focal or diffuse severe transient luminal narrowing (>70%) with/without chest pain or ST-T change on ECG. We divided into two groups according to provocation agent: 1) the Erg group (n=210), 2) the Ach group (n=1,987). We investigated whether there are differences in clinical and angiographic characteristics according to intracoronary Erg or Ach provocation test. Results Baseline clinical characteristics were similar between the two groups except the Erg group were more male (46.7% vs 37.9%, p = 0.014) and dyslipidemia (45.2% vs 22.5%, p = <0.001). During the provocation test, the higher rates of myocardial bridge, Chest pain, atrioventricular node block, and positive CAS results were shown in the Ach group. the Erg group received a higher frequency of a high concentration dose compared with the Ach provocation test. In CAS positive patients, the Ach group had higher rates of spasm in the left anterior descending artery and mid site, but lower proximal site. Conclusion We observed difference between these two agents on clinical and angiographic parameters in provocation tests. Ach was more sensitive even to lower Ach dose as compared to Erg in elderly patients. Further study would be of major importance to validate the different parameters and different positive rates between the two agents with larger study population.