Harding M B, Leithe M E, Mark D B, Nelson C L, Harrison J K, Hermiller J B, Davidson C J, Pryor D B, Bashore T M
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710.
J Am Coll Cardiol. 1992 Jul;20(1):107-11. doi: 10.1016/0735-1097(92)90145-d.
The utility of ergonovine testing for coronary artery spasm was assessed in 3,447 patients with angiographically insignificant (less than 50% diameter stenosis) or no coronary artery disease. No patients clinically had Prinzmetal's variant angina. Overall, 4% had a positive ergonovine test result, defined by spasm causing greater than or equal to 75% focal stenosis. Complications related to ergonovine use occurred in 11 patients (0.03%). In a training sample of 1,136 patients (studied between 1980 and 1984), two independent predictors of spasm were found by using multivariate analysis: the amount of visible coronary artery disease on the coronary angiogram (p less than 0.0001) and a smoking history (p = 0.001). A model to predict spasm based on these variables was validated in a test group of 2,311 patients who received ergonovine from 1985 to 1989. This model allowed the identification of a subset of 400 patients in the validation sample who had a 10% positive test rate compared with a 2% positive test rate in the remaining patients. These results should permit clinicians who use provocative testing in the catheterization laboratory to reserve testing for the subset of this group of patients most likely to have abnormal findings.
在3447例血管造影显示无明显冠状动脉疾病（直径狭窄小于50%）或无冠状动脉疾病的患者中，评估了麦角新碱试验对冠状动脉痉挛的诊断价值。临床上无患者患有变异型心绞痛。总体而言，4%的患者麦角新碱试验结果为阳性，定义为痉挛导致局灶性狭窄≥75%。11例患者（0.03%）出现了与使用麦角新碱相关的并发症。在1980年至1984年间研究的1136例患者的训练样本中，通过多变量分析发现了两个痉挛的独立预测因素：冠状动脉造影上可见的冠状动脉疾病程度（p<0.0001）和吸烟史（p = 0.001）。基于这些变量预测痉挛的模型在1985年至1989年接受麦角新碱治疗的2311例患者的测试组中得到验证。该模型在验证样本中识别出400例患者亚组，其阳性测试率为10%，而其余患者的阳性测试率为2%。这些结果应使在导管实验室进行激发试验的临床医生能够为这组最有可能有异常发现的患者亚组保留试验。
