Safety and clinical implications of coronary spasm provocation testing in patients presenting with myocardial infarction with no overt culprit lesion.
Academic Article
Overview
abstract
BACKGROUND: Acetylcholine (ACh) provocation testing is a critical diagnostic tool for identifying coronary artery spasms in patients presenting with angina pectoris or myocardial infarction (MI) who do not exhibit obstructive coronary artery disease. Despite its utility, the use of ACh testing is limited due to concerns regarding potential life-threatening complications and a historical underrepresentation of MI populations in clinical research. METHODS: This registry-based study analyzed 1063 patients with 115 presenting with MI and 948 without (non-MI), who underwent ACh spasm provocation testing. The primary safety endpoints include arrhythmic and other acute complications. The primary clinical endpoint was the incidence of major adverse cardiac events (MACE). The median follow-up was 2.4 years. RESULTS: The ACh testing showed low incidences of major cardiovascular complications with no incidences of procedure-related death. Additionally, rates of fatal ventricular arrhythmia, cardiogenic shock, and procedure-related myocardial infarction showed no significant differences between the MI and non-MI patient groups. There was no significant difference in MACE between MI and non-MI groups stratified based on the ACh test responses. Multivariable analysis revealed that ST-segment elevation and diabetes mellitus were associated with a higher rate of MACE in MI patients with positive ACh tests (adjusted hazard ratio 10.98 [95 % CI: 1.14-106.07] and 8.80 [1.14-68.11], respectively). CONCLUSIONS: The present study suggests that ACh provocation testing is safe for patients with MI, validating its expanded use in clinical settings. ST-segment elevation may serve as a prognostic marker for stratifying risk and optimizing management in patients evaluated for coronary artery spasm.
