Differences in Clinical and Angiographic Characteristics Following Intracoronary Ergnovine and Acetylcholine Provocation Test in Hypertension Patients

초록

Background Ergnovine (Erg) and Acetylcholine (Ach) are useful agents for assessing significant coronary artery spasm (CAS). However, comparison studies of the two agents are limited in hypertension patients. Methods A total of 3,818 hypertension patients (pts) 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=284), 2) the Ach group (n = 3,534). 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 elderly (62.3 years vs 60.3 years, p = 0.003), male (53.5% vs 47.3%, p = 0.044) and dyslipidemia (47.5% vs 26.4%) but lower rates of peripheral artery disease (2.5% vs 5.3%, p = 0.034). 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, proximal, but lower proximal site (table). Conclusion Clinical and angiographic parameters were different between Erg and Ach provocation tests. Further study would be needed to validate the different parameters and different positive rates between the two agents in hypertension patients.