Adlam David, Azeem Tariq, Ali Turab, Gershlick Anthony
Department of Cardiology, Glenfield Hospital, Groby Road, Leicester LE3 9QP, England.
Int J Cardiol. 2005 Jun 22;102(1):1-7. doi: 10.1016/j.ijcard.2004.07.016.
Spontaneous coronary artery spasm is an important cause of morbidity both in patients with coronary artery disease and in those with variant angina. A number of pharmacological agents have been identified which can provoke coronary artery spasm in susceptible patients. The role of provocation testing in the clinical diagnosis of coronary spasm is controversial. This is reflected by variations in the clinical use of provocation testing between specialist cardiac centres. Provocation testing appears to be a sensitive method of identifying patients with variant angina and active disease but such patients can often be diagnosed clinically. The specificity is less clear. There is little evidence that altering patient therapy on the basis of a positive test modifies prognosis. There may be a role for provocation testing in rare patients with refractory disease to identify a target site for coronary stenting. A more widespread use of these tests in patients with undiagnosed chest pain syndromes would not currently be recommended.
自发性冠状动脉痉挛是冠心病患者和变异型心绞痛患者发病的重要原因。已确定多种药物可在易感患者中诱发冠状动脉痉挛。激发试验在冠状动脉痉挛临床诊断中的作用存在争议。这体现在心脏专科中心之间激发试验临床应用的差异上。激发试验似乎是识别变异型心绞痛和活动性疾病患者的敏感方法，但这类患者通常可通过临床诊断。其特异性尚不清楚。几乎没有证据表明基于阳性试验改变患者治疗可改善预后。对于罕见的难治性疾病患者，激发试验可能有助于确定冠状动脉支架置入的靶点。目前不建议在未确诊胸痛综合征患者中更广泛地使用这些试验。
