Intracoronary Ergonovine Provocation Test in Patients with Coronary Artery Spasm

Han, Kyoo Rok; Choi, Dong Ju; Choi, Young Jin; Park, Sun Soo; Kim, Yong Jin; Sohn, Dae Won; Oh, Byung Hee; Lee, Myoung Mook; Park, Young Bae; Choi, Yun Shik; Seo, Jung Don; Lee, Young Woo

Abstract

BACKGROUND
Intravenous ergonovine and intracoronary acetylcholine tests have been used to induce coronary artery spasm, however, potential preblems with each test require a safer and more specific test.
METHODS
To evaluate the usefulness of the intracoronary ergonovine provocation test in patients with coronary artery spasm, this test was performed in 83 patients(male 47, female 36) with normal or near-normal looking coronary angiography or insignificant lesion less than 50% in diameter after routine diagnostic coronary angiography. Ten micrograms of ergonovine maleate diluted in 1 ml of saline was injected into right coronary artery up to 2 times and into left coronary artery up to 3 times. Induction of coronary arterial narrowing more than 75% of luminal diameter with typical chest pain and/or ECG changes in two or more adjacent leads was considered as a positive test.
RESULTS
Intracoronary ergonovine provocation tests were positive in 33 patients among 83 patients. In 24 patients, coronary artery spasm was induced in RCA, 12 patients in LAD and 8 patients in LCX. Coronary artery spasm of 2 sites was observed in 11 patients. In 27 patients, typical chest pain was developed with spasm. The ECG changes during spasm were ST elevation in 19 patients, ST depression in 3 patients, T wave change only in 2 patients and no change in 9 patients. The provocation tests showed focal spasm in 23 patients(70%) and diffuse spasm in 10 patients(30%).
CONCLUSION
Intracoronary ergonovine provocation test appears to be a safe and effective method to provoke the coronary artery spasm.