Prognostic Value of Intracoronary Ergonovine Provocation Test | Journal Scan

Study Questions:

What are the clinical characteristics and 24-month prognosis of patients who undergo intracoronary ergonovine provocation tests?

Methods:

The investigators classified a total of 2,129 patients in the VA-KOREA (Vasospastic Angina in Korea) registry into positive (n = 454), intermediate (n = 982), and negative (n = 693) groups by intracoronary ergonovine provocation tests. The 24-month incidences of cardiac death, new-onset arrhythmia, and acute coronary syndrome were determined (mean 26.7 ± 8.8 months).

Results:

The number of smokers, frequency of angina before angiography, high-sensitivity C-reactive protein, and triglyceride were higher in the positive group than in other groups. The clinical characteristics of the intermediate and the negative groups were very similar. In the positive group, the incidences of diffuse, focal, and mixed spasm were 65.9%, 23.6%, and 10.6%, respectively. Coronary spasm was more frequently provoked on atherosclerotic segments. The 24-month incidences of cardiac death, arrhythmia, and acute coronary syndrome were low (0.9%, 1.6%, and 1.9%, respectively) in the positive group, and there was no cardiac death in the intermediate group (p = 0.02). In the positive group, frequent angina, current smoking, and multivessel spasm were independent predictors for adverse events.

Conclusions:

The authors concluded that the 24-month prognosis of the positive group in the intracoronary ergonovine provocation test was relatively worse than that of the intermediate group.

Perspective:

This study reports that the 24-month clinical outcomes of the positive group in the intracoronary ergonovine provocation test were relatively worse than those of the intermediate group. Appropriate clinical attention should be paid to vasospastic angina patients with high risk factors including frequent angina before angiography, current smoking, and multivessel spasm. Future prospective registries and randomized controlled clinical trials would be useful in providing additional insight for optimal identification and management of individuals with vasospastic angina.

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Prevention, Stable Ischemic Heart Disease, ACS and Cardiac Biomarkers, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Lipid Metabolism, Interventions and ACS, Interventions and Imaging, Angiography, Nuclear Imaging, Smoking, Chronic Angina

Keywords: Acute Coronary Syndrome, Angina Pectoris, Angina Pectoris, Variant, Angiography, Arrhythmias, Cardiac, C-Reactive Protein, Coronary Vasospasm, Ergonovine, Incidence, Prognosis, Registries, Risk Factors, Smoking, Spasm, Triglycerides


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