Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Germany,
Clin Res Cardiol. 2014 Jan;103(1):11-9. doi: 10.1007/s00392-013-0615-9. Epub 2013 Sep 1.
Coronary angiography is often performed in patients with recurrent or ongoing angina after successful percutaneous coronary intervention (PCI) in search of an in-stent restenosis (ISR). However, in many of these patients, no significant ISR can be detected. We speculate that enhanced coronary vasoconstriction represents an alternative explanation for angina in these patients.
From 1,285 patients with angiographically unobstructed coronaries (no stenosis ≥50 %) who underwent intracoronary acetylcholine provocation testing (ACH-test) between 2008 and 2011, we consecutively recruited 104 patients (42 female (40 %), mean age 64 ± 11 years) who fulfilled the following inclusion criteria: previous stent implantation due to obstructive coronary artery disease (CAD), ongoing/recurrent exertional angina, no significant (<50 %) ISR.
In fifty-one patients with previous PCI (49 %), the ACH-test elicited enhanced epicardial vasoconstriction (≥75 % diameter reduction with reproduction of the patient's symptoms) and microvascular vasoconstriction (reproduction of symptoms, ischemic ECG-changes and no epicardial vasoconstriction) was seen in 18 additional patients (17 %). The ACH-test was uneventful in the remaining 35 patients (34 %). Epicardial vasoconstriction in patients with previous PCI was most often distal and diffuse (31/51, 61 %, p < 0.01).
Enhanced epicardial and microvascular coronary vasoconstrictions are frequently found in patients with stable angina after successful PCI but without significant ISR. Intracoronary acetylcholine provocation testing may be useful in these patients to determine the cause of angina and initiate appropriate medical treatment.
经皮冠状动脉介入治疗（PCI）成功后，对于反复发作或持续存在心绞痛的患者，常进行冠状动脉造影以寻找支架内再狭窄（ISR）。然而，在许多这样的患者中，并未检测到明显的 ISR。我们推测，增强的冠状动脉收缩可能是这些患者心绞痛的另一种解释。
从 2008 年至 2011 年期间，对 1285 例冠状动脉造影无阻塞（狭窄程度<50%）的患者进行了冠状动脉内乙酰胆碱激发试验（ACH 试验），我们连续招募了 104 例符合以下纳入标准的患者（42 例女性（40%），平均年龄 64±11 岁）：先前因阻塞性冠状动脉疾病（CAD）植入支架、持续/复发的劳力性心绞痛、无明显的（<50%）ISR。
在 51 例先前接受 PCI 的患者（49%）中，ACH 试验引起了明显的冠状动脉收缩（≥75%的血管直径减少，同时重现患者的症状），18 例患者（17%）同时出现微血管收缩（症状重现、缺血性心电图改变且无冠状动脉收缩）。其余 35 例患者（34%）ACH 试验无不良事件发生。先前接受 PCI 的患者的冠状动脉收缩主要为远端弥漫性（31/51，61%，p<0.01）。
在 PCI 成功后稳定型心绞痛且无明显 ISR 的患者中，常发现明显的冠状动脉收缩（包括心外膜和微血管）。冠状动脉内乙酰胆碱激发试验可能有助于确定这些患者心绞痛的病因，并启动适当的药物治疗。
